Lecture 3 - types of ECMO

Question 1

What is ECLS used for?

Answer 1

Cardiac Failure
-the inability of the heart to supply sufficient blood flow to meet the needs of the body.
Respiratory Failure
-inadequate gas exchange by the respiratory system, resulting in arterial O2 and/or CO2 levels failing to be maintained in normal ranges

Question 2

lactate levels are the marker on ECMO for what?

Answer 2

for how you are perfusing the tissue

Question 3

Who is on the waiting list for ECMO

Answer 3

Primary Respiratory Failure (neonatal)
Primary Cardiac Failure(all)
Primary Respiratory Failure (adults)
Primary Respiratory Failure (peds)

Question 4

Primary Respiratory Failure (neonatal) causes?

Answer 4

Meconium Aspiration
Sepsis
CDH
Persistent Pulmonary Hypertension(PPHN)
*Increased PAP will lead to intrapulmonary shunting hypoxia and acidosis develop

Question 5

ELSO Neonatal Criteria Indications

How to calculate the Oxygenation Index??

Answer 5

Mean airway P x FiO2 x 100/Post ductal PaO2

OI= 20 consider ECLS, OI=40, ECLS indicated

Question 6

Oxygenation Index of 20 - what do you do?

Answer 6

consider ECLS

Question 7

Oxygenation index of 40 what do you do?

Answer 7

ECLS indicated

Question 8

Primary Cardiac Failure (neonate or adult) causes?

Answer 8

Post-cardiotomy failure –unable to wean from CPB
Myocarditis
Cardiomyopathy
Cardiogenic shock
Sepsis

Question 9

ELSO Cardiac Criteria (5)

Answer 9

Cardiac Index -5 x 3 hours but less than 12 hours
Mean BP w/oliguria:
NB

Question 10

ELSO Cardiac Criteria of Cardiac Index?

Answer 10

Cardiac Index

Question 11

ELSO Cardiac Criteria of Base Deficit

Answer 11

> -5 x 3 hours but less than 12 hours

Question 12

ELSO Cardiac Criteria of Mean BP w/oliguria?

Answer 12

Mean BP w/oliguria:

NB

Question 13

Primary Respiratory Failure (Adults and Peds)

Answer 13

Adult respiratory distress syndrome (ARDS)
Pneumonia
Viral
Trauma
Primary graft failure following lung transplantation

Question 14

When you are femorally cannulated what do you want to keep an eye on?

Answer 14

Pedal Pulses (doral pedal pulse) to makes sure there is perfusion

Question 15

ELSO Pediatric Criteria

Indications - time frames?

Answer 15

While no absolute indicators are known, consideration for ECMO is best within the first 7 days of mechanical ventilation at high levels of support

Question 16

Cardiac Stun?

Answer 16

can see this when you go on ECMO sometimes bc you are stealing all of the good blood from the coronaries, especially if you are femoraly cannulated (arterial) bc the good blood is flowing against native CO and doesn’t always make it to the heart

Question 17

ELSO Adult Respiratory Criteria

Answer 17

Hypoxic respiratory failure due to any cause (primary or secondary) ECLS should be considered when the risk of mortality is 50% or greater, and is indicated when the risk of 80% or greater.

a. 50% mortality risk can be identified by a PaO2/FiO2 90% and/or Murray score 2-3
b. 80% mortality risk can be identified by a PaO2/FiO2 90% and Murray score 3-4

Question 18

ELSO Adult Respiratory Criteria - 50% mortality can be identifies by what? what is the score?

Answer 18

a. 50% mortality risk can be identified by a PaO2/FiO2 90% and/or Murray score 2-3

Question 19

ELSO Adult Respiratory Criteria - 80? mortality risk can be identified by what? what is the score?

Answer 19

b. 80% mortality risk can be identified by a PaO2/FiO2 90% and Murray score 3-4

Question 20

is the saturation in your venous line in an ECMO circuit the same as the patient’s?

Answer 20

NO. bc you could be having mixing or not perfect perfusion so it is not the patient’s true venous sat. So you need to take it from a different actual part of the body

Question 21

Adult respiratory criteria?

Answer 21

• -CO2 retention due to asthma or permissive hypercapnia with a PaCO2 > 80
• -Inability to achieve safe inflation pressures (Pplat ≤ 30 cm HO) is anindication for ECLS.
• -Severe air leak syndromes

Question 22

V-V ECMO (with a dual lumen cannula)– how do you add an arterial cannula to the circuit?

Answer 22

Come off bypass
hand up cannula (8 Fr DLP arterial cannula) to surgeon and he will put it in the carotid
than you have your two venous that you wye together for better venous return

Question 23

Patient selection for ECMO remember something?

Answer 23

Poor selection = poor outcomes

Question 24

Types of ECMO Support – Normal Techniques

Answer 24

Venous-Arterial (VA)
Veno-venous (VV)
VV Dual lumen (VVDL)

Question 25

Types of ECMO support – Modified Conversion Techniques

Answer 25

VA-V (VA gets additional venous return)
VV-A (VV becomes VVA)
VVDL-A (VVDL becomes VVDL-A)

Question 26

Choose between what two areas for cannulation on ECMO?

Answer 26

Peripheral or Central

Question 27

STOPPED AT SLIDE 19/68

Answer 27

Stoppped 19/68