ECMO

Question 1

What are the basic principles for determining if a pt is a good candidate for ECMO?

Answer 1

-lack of response to conventional ventilator management
-lack of response to rescue interventions for severe hypoxemic or hypercarbic respiratory failure
-has an underlying process that is potentially reversible
-no contraindications to ECMO

Question 2

What is the most common cannulation strategy for VV ECMO?

Answer 2

femoral drainage and jugular reinfusion

Question 3

On VV ECMO what ventilator strategy should be used to provide lung protection and recovery?

Answer 3

limit maximum plateau pressure to 24cmH2O w/ PEEP >/= 10
-this is a driving pressure </= 14
respiratory rate of 10-30 breaths/min
FiO2 0.3-0.5
PC can be easier that VC d/t poor lung compliance

Question 4

Why is low dose anticoagulation used in ECMO?

Answer 4

-preserve the gas exchange membrane’s efficiency
-increase the circuit longevity
-mitigate the risk of thromboemoblic complications

Question 5

What is the common anticoagulation approach to ECMO?

Answer 5

heparin bolus of 50-100u/kg on cannulation followed by 7.5-20u/kg/hr infusion w/ PTT goal of 1.5-2x normal

Question 6

What percent of ECMO cases require renal replacement therapy?

Answer 6

40-60%

Question 7

What is the most common indicator for RRT for patients on ECMO?

Answer 7

fluid overload (esp. in pedi)

Question 8

What is typically the limiting factor when it comes to adequate ECMO flow rates?

Answer 8

venous drainage insufficiency
-venous drainage pressures < -100mmHg are associated with flow limitations
-fix with adding an additional drainage cannula to increase flow

Question 9

What percent of patients decannulated after VV ECMO develop a venous thromboembolism?

Answer 9

30-50%