ECMO Flashcards
What is used to prime the ecmo pump?
Normosol
10,000 units Heparin
200 cc 25% Mannitol
50 mEq’s Bicarb
200 mg Lidocaine
80 mEq’s K+
5 grams Magnesium
What is the AV loop?
The AV Loop is the connection of the patients venous system to the patients arterial system with an extracorporeal circuit
Venous cannula drains RA into the venous reservoir.
Arterial line returns filtered blood through cannula which is inserted into the aorta
Where is arterial cannulation inserted?
Cannula inserted into the ascending aorta to deliver oxygenated blood to the body
Where is venous cannulation inserted?
2 stage cannula inserted into right atrium. Basket in mid cannula sits in right atrium to drain upper body and basket at the tip sits in inferior vena cava to drain the lower body
Drainage is done by gravity but vacuum can be added if neccesary
What acts as the atrium of the
heart-lung machine circuit?
Venous Reservoir
Can vacuum can be added to assist in drainage to gain more patient volume & empty the heart if needed?
Yep!
Venous O2 Saturation Monitor
♥ Constant in line measurement of both venous O2 saturation
and hct
♥ Good tool to tell whether adequate perfusion is being
achieved
Bubble Detector
♥ Safety mechanism which protects patient from receiving an air
embolus
♥ Easily placed on any portion of pump tubing
E Clamp
The E Clamp is a safety device that is attached to the arterial line. It’s function is to stop arterial flow to the patient when either air or low blood volume is detected
Is the centrifugal pump safer than the roller pump?
Yep
Are All pump types are hemolytic to some degree?
YES. Hemolysis increases logarithmically over time.
What is considered the heart of the ecmo pump?
The pump console. Allows adjustment in raising or lowering blood flow. In other words managing patient’s cardiac output. LPM
What is the primary function of the Oxygenator – Heat Exchanger?
♥ Primary function is the oxygenation & removal of CO2 from blood. This is the “ Lung “
♥ Secondary function is blood temperature management.
How is the patient heated or cooled?
Via blood circulation
How much does the metabolic rate lower for each degree celcius the patient is cooled?
Lowering 1 degree celsius reduces metabolic rate by 7%
O2 Blender
Allows perfusionist to control the FIO2 and the delivery speed of the oxygen-air mixture to the oxygenator
♥ Mimics ventilator
Desflurane / Isoflurane Vaporizer
Lowers chance of recall
Allows heart to survive a longer period of time before injury due to ischemia.
“Anesthesia Preconditioning”
Quick On-Off properties due to its low blood gas solubility makes it very manageable to control BP
What is the last safety device before blood enters patient?
Arterial Filter
It Removes air micro- and macro-bubbles via purge line
What provides safety mechanism for the heart lung machine by verifying proper placement of aortic cannula and assuring that over pressurization of the circuit does not occur
Arterial Line Manometer
What is filtered cardiotomy?
Following systemic heparinization pump suckers can be turned on & blood is scavenged to this filtered reservoir.
Receives blood from surgical field via pump suctions
What does the Aortic Root Vent do?
Retrieves blood out of the left side of the heart so it does not distend
If proper venting does not occur then LV distention
results
How is cardiac arrest achieved?
via high K+ infusion via the following routes:
aortic root
coronary sinus (retrograde)
vein grafts
coronary ostia
Cardioplegia system
♥ High K+ infusion has
significant vasodilatory effect
♥ Magnesium helps
membrane stability
♥ Quest Microplegia system
allows “on the fly”
adjustments
♥ Built in heat exchager to
regulate temperature of
perfusate
What is a major benefit of cardioplegia
♥ Due to the fact that blood is used as the delivery solution instead of a crystalloid solution, hemodilution of the patient is significantly reduced
ACT while on ecmo
Everyone is heparinized before going on pump. ACT’s are kept at > 480 sec
Cell saver
♥ Washed RBC’s in
normal saline is
concentrated at Hct 50-
75% and pumped to a
transfusion bag.
♥ Large amounts of “cell
saver” blood indicates
large plasma loss.
*Disadvantage
♥ Even though RBC’s are
saved and returned to
increase patient’s Hct,
all other formed
elements of the patient’s
blood are “washed” off
especially clotting
factors. End result is
potential bleeding problems
with massive blood loss
Arthrex Angel- ”Platelet Gel” Machine
The poor is a band-aid that holds the rich in place
Platelet “POOR” Application
Contains mostly plasma with few platelets
Recommended for use in platelet aggregation
Applied on top of “RICH” to hold it in place like a bandage
Protocol Summary
♥ Minimum Hct
Cold – 21%
Warm – 24%
♥ MAP 60-90mmHg
♥ Urine 1-2cc/kg/hr
♥ Temperature – Drift to
32 degrees Celsius
