ECMO Flashcards
ECMO
An ECMO is an extrapulmonary form of support that is used to provide oxygenation and/or ventilation for the blood
How Long is ECMO Used For
ECMO is a longer version of the cardiopulmonary bypass
Cardiopulmonary bypass is used for hours
ECMO can be used for up to 10 days
Venoarterial (VA)
Provides both respiratory and hemodynamic support
Offloads both the lung and heart
Venovenous (VV)
Provides respiratory support only
How Venovenous Works
The ECMO pump delivers venous blood to the oxygenator which will divide the blood into two separate chambers by the semi permeable membrane
The venous blood will enter the oxygenator and travel along one side of the membrane (blood side) while fresh gas know as the sweep gas is delivered to the other side(gas side)
Gas exchange (oxygen uptake and CO2 elimination) take place across the membrane
The oxygenated blood is then reinfused into the patient venous system
The composition of the gas on the gas side of the oxygenator membrane is determined by the adjustment of a blender that mixes room air with oxygen for deliver into oxygenator
Single Site Approach to Venovenous ECMO Cannulation
Dual lumen cannula is inserted in the internal jugular vein (extending through the right atrium and into the inferior vena cava
Venous bloods is withdrawn through one drainage lumen with ports in both the superior and inferior vena cava
Reinfusion of oxygenated blood occurs through the second lumen with a part situated in right atrium
The two-drainage port lumen are situated in superior and inferior vena cava distant from the reinfusion port
The reinfusion port is positioned so that the oxygenated blood is directed across the tricuspid and directly into the right ventricle
This arranged significantly reduced recirculation of blood when the cannular is properly positioned
Blood would be reintroduced into the arterial side for the VA type
ECMO Typical Uses
Criteria for the initiation of ECMO include acute severe cardiac or pulmonary failure that is potentially reversible and unresponsive to conventional management
Hypoxemic respiratory failure with a ratio of arterial oxygen tension to fraction of inspired oxygen (PaO2/FiO2) of <100 mmHg despite optimization of the ventilator settings, including the Fraction of Inspired Oxygen (FiO2), positive end-expiratory pressure (PEEP), and inspiratory to expiratory (I:E) ratio
Hypercapnic respiratory failure with an arterial pH <7.20
Refractory cardiogenic shock
Cardiac arrest
Failure to wean from cardiopulmonary bypass after cardiac surgery
As a bridge to either cardiac transplantation or placement of a ventricular assist device
Main Condition ECMO Used in Adults
severe ARDS, severe asthma
Main Condition ECMO Used in Neo
PPHN (primary, or associated with pneumonia, MAS, RDS) and CDH
Risks
Bleeding
Thrombosis
Remember whenever you take blood out of the body the risk of clots increases so the patients will have to be on anti coagulants
Infection
DIC
Nova Lung
A membrane ventilator
Provides pumpless arterio-venous extrapulmonary lung support
Relies on the patient’s blood pressure to drive the system
Uses simple diffusion to provide oxygenation and ventilation
Air flow through the Novalung.
Configuration of the hollow fiber system.
The blood surrounds the tubular system.
The big difference is that it is pumpless so the heart has to generate sufficient blood pressure to circulate blood through the device
When echmo is running the ventilator will have a set rate and Vt to keep the lung moving but these are very small
