Ch. 16 ECMO

Question 1

ECMO Patient Selection

Answer 1

NO if active bleeders, terminal disease, NS damage, pulm fibrosis
YES if acute pulm failure, ARDS (acute respiratory distress syndrome high cap perm), bridge to tx

Question 2

Cannulation Locations for V-A and V-V

Answer 2

VA

• Venous= right internal jugular into RA
• Arterial= R common carotid

VV- Right heart bypass

• Venous= SVC/right internal jugular
• Arterial= IVC thru femoral

Question 3

ECMO Oxygenator

Answer 3

true membrane** silicone sold sheet (NOT micropore membrane)

-can withstand 20 L of gas flow

Question 4

Circuit 3 special things

Answer 4

• venous bag
• cross over bridge
• hemoconcentrator (needs separate roller heart)

Question 5

are VV ECMO SvO2 accurate?

Answer 5

no because it recirculates (outflow is SVC, inflow into body is IVC), so oxygenated blood recirculates
want normal SvO2 70-80%

Question 6

Conditions to Wean, SvO2 with FiO2 of?

Answer 6

SvO2 >60% with FiO2 < .6

Question 7

Wean

Answer 7

decrease 1 liter every 2 hours and stop pump at 2 l/min

-want ACT of 350 while weaning

Question 8

ECMO Infants

Answer 8

• mostly used for respiratory issues (hyaline membrane disease)
• 80 % successful
• mostly VA ECMO
• keep on ventilator
• **keep FiO2 < .3= oxygen toxicity- eye damage
• ACT 250
• BF 150 mL/kg/min
• HCT 40%