ECMO

Question 1

What is used to prime the ecmo pump?

Answer 1

Normosol

10,000 units Heparin

200 cc 25% Mannitol

50 mEq’s Bicarb

200 mg Lidocaine

80 mEq’s K+

5 grams Magnesium

Question 2

What is the AV loop?

Answer 2

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

Question 3

Where is arterial cannulation inserted?

Answer 3

Cannula inserted into the ascending aorta to deliver oxygenated blood to the body

Question 4

Where is venous cannulation inserted?

Answer 4

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

Question 5

What acts as the atrium of the
heart-lung machine circuit?

Answer 5

Venous Reservoir

Question 6

Can vacuum can be added to assist in drainage to gain more patient volume & empty the heart if needed?

Answer 6

Yep!

Question 7

Venous O2 Saturation Monitor

Answer 7

♥ Constant in line measurement of both venous O2 saturation
and hct

♥ Good tool to tell whether adequate perfusion is being
achieved

Question 8

Bubble Detector

Answer 8

♥ Safety mechanism which protects patient from receiving an air
embolus

♥ Easily placed on any portion of pump tubing

Question 9

E Clamp

Answer 9

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

Question 10

Is the centrifugal pump safer than the roller pump?

Answer 10

Yep

Question 11

Are All pump types are hemolytic to some degree?

Answer 11

YES. Hemolysis increases logarithmically over time.

Question 12

What is considered the heart of the ecmo pump?

Answer 12

The pump console. Allows adjustment in raising or lowering blood flow. In other words managing patient’s cardiac output. LPM

Question 13

What is the primary function of the Oxygenator – Heat Exchanger?

Answer 13

♥ Primary function is the oxygenation & removal of CO2 from blood. This is the “ Lung “

♥ Secondary function is blood temperature management.

Question 14

How is the patient heated or cooled?

Answer 14

Via blood circulation

Question 15

How much does the metabolic rate lower for each degree celcius the patient is cooled?

Answer 15

Lowering 1 degree celsius reduces metabolic rate by 7%

Question 16

O2 Blender

Answer 16

Allows perfusionist to control the FIO2 and the delivery speed of the oxygen-air mixture to the oxygenator
♥ Mimics ventilator

Question 17

Desflurane / Isoflurane Vaporizer

Answer 17

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

Question 18

What is the last safety device before blood enters patient?

Answer 18

Arterial Filter

It Removes air micro- and macro-bubbles via purge line

Question 19

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

Answer 19

Arterial Line Manometer

Question 20

What is filtered cardiotomy?

Answer 20

Following systemic heparinization pump suckers can be turned on & blood is scavenged to this filtered reservoir.

Receives blood from surgical field via pump suctions

Question 21

What does the Aortic Root Vent do?

Answer 21

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

Question 22

How is cardiac arrest achieved?

Answer 22

via high K+ infusion via the following routes:
aortic root
coronary sinus (retrograde)
vein grafts
coronary ostia

Question 23

Cardioplegia system

Answer 23

♥ 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

Question 24

What is a major benefit of cardioplegia

Answer 24

♥ Due to the fact that blood is used as the delivery solution instead of a crystalloid solution, hemodilution of the patient is significantly reduced

Question 25

ACT while on ecmo

Answer 25

Everyone is heparinized before going on pump. ACT’s are kept at > 480 sec

Question 26

Cell saver

Answer 26

♥ 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

Question 27

Arthrex Angel- ”Platelet Gel” Machine

Answer 27

The poor is a band-aid that holds the rich in place

Question 28

Platelet “POOR” Application

Answer 28

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

Question 29

Protocol Summary

Answer 29

♥ Minimum Hct
Cold – 21%
Warm – 24%
♥ MAP 60-90mmHg
♥ Urine 1-2cc/kg/hr
♥ Temperature – Drift to
32 degrees Celsius