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ECMO > Blood Gas Mixology and Weaning! > Flashcards

Blood Gas Mixology and Weaning! Flashcards

1
Q

VA ECMO is a _______ circuit.

A

Parallel Circuit

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2
Q

VV ECMO is a _______ circuit.

A

Series Circuit

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3
Q

VA Ecmo Circuit

A

Patient Venous Blood –> Native Heart Lung/Artificial Heart Lung –> Patient Arterial Blood

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4
Q

VV ECMO Circuit

A

patient venous blood –> Artificial Lung –> native lung –> patient arterial blood

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5
Q

VA ECMO: Central Cannulation

A

Typically right atrium to aorta
used for patients with open chests (post-CPB)
ideal for high-flow ecmo

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6
Q

VA ECMO: Peripheral cannulation

A

TYpically femoral vein to femoral artery
Can be used without opening hte chest
may cause limb ischemia
risk of coronary/brain ischemia

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7
Q

Assumption (for now) of VA ECMO

A

100% patient blood flow is being provided by the ECMO system no blood is traversing hte lungs and being ejected by the heart

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8
Q

What can we control? (Arterial blood)

A

PCO2/pH
pO2
ECMO Blood flow

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9
Q

pCO2/pH

A

PCO2 can be controlled by the sweep (ventilation) rate. increased sweep leads to decreased pCO2 and vice versa

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10
Q

pO2

A

pO2 can be controlled by manipulating hte fraction of inspired oxygen (FiO2). Increased FiO2 leads to increased pO2

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11
Q

ECMO Blood Flow

A

increasing RPM leads to increased flow and therefore increased oxygen delivery

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12
Q

Gas:Blood Flow Ratio

A

For a given sweep rate, changing the blood flow has an affect on the amount of co2 removed by the oxygenator

as the blood flow is decresaed, the blood has a prolonged exposure to the oxygenator’s fibers, resulting in more CO2 being “blown off”; the reverse is true as well

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13
Q

how can a low venous saturation be managed?

A

Increase oxygen delivery

Decrease metabolism

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14
Q

Increase oxygen delivery

A

increase oxygenation (increase ventilatior or ECMO settings?)
Increase ECMO blood flow
RBC transfusion

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15
Q

Decrease metabolism

A

hypothermia

sedatives/paralytics

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16
Q

Mixology refers to…

A

concept of “dual circulations”
impact of cannulation site of blood mixing
impact of cardiac function and ECMO blood flow on the Mixing cloud and regional blood gases

17
Q

Location of hte “mixing cloud” depends on

A

cannulation site
rate of ECMO blood flow
cardiac contractility
ECMO mode (VA vs VV)

18
Q

When would ECMO ABG = Patient ABG

A

If the aortic valve is not opening, no blood is being ejected form the heart therefore all arterial blood flow is being provided by the ECMO system

19
Q

With __________ cannulation, blood will generally be uniform throughout the body even if the aortic valve is opening and the heart is ejecting.

A

Central cannulation

20
Q

What are some exceptions of blood being uniform with central cannulation?

A

Coronaries, poor cannula position

21
Q

With ________ cannulation, the two circulations “compete for space” in the vasculature

A

femoral (peripheral)

22
Q

Veno-Veno ECMO

A

No arterial cannulation
Arterial blood is always uniform becuase mixing of ECMO and native blood happens in/near the right atrium
ABGs drawn form ECMO circuit should be considered largely independent of patient ABGs
ECMO ABG does not equal patient ABG

23
Q

ECMO oxygenation will be most effective when…..

A

ECMO flows are high
Cannula recirculation is low
Amount of blood bypassing hte cannula is low
oxygenator performance in high

24
Q

Weaning- VA ECMO

A

WEaning from VA ECMO should always be done by decreasing ECMO blood flow (RPM)
there is significant risk of circuit thrombus formation during periods of low (or no ) flow

25
Q

Weaning -VV ECMO

A

DOne in a number of ways but the proper method is decreasing sweep and FIO2

26
Q

Why is decreasing sweep and FiO2 the best method for weaning VV ECMO?

A

decreasing sweep/ FiO2 will not negatively effect the patient’s arterial blood gases as long as the lungs are functioning properly
Easy to “trial off”
Decreasing RPM/blood flow = risk of circuit clot

27
Q

VV ECMO- Preweaning

A

The blood exiting hte artificial lung is poorly oxygenated but this is not problematic as long as the lungs are functioning

28
Q

VV ECMO- Intiial Weaning

A

The blood exiting the artificial lung is poorly oxygenated, but this is not problematic as long as the lungs are functioning

29
Q

VV ECMO-Further Weaning

A

The blood exiting hte artificial lung is poorly oxygenated but thie is not problematic as long as the lungs are functioning

30
Q

Weaning- RVAD ECMO

A

weaning from RVAD ecmo should be done similarly to VV ECMO by decreasing FiO2 and sweep (not blood flow)

ECMO (7 decks)

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