Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

ECMO > Types of ECMO Support > Flashcards

Types of ECMO Support Flashcards

1
Q

Who can benefit from ECMO?

A

Patients who have reversible lung and/or heart condition that has responded maximal medical therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is ECMO utilized for?

A

Cardiac Failure

Respiratory failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Cardiac Failure

A

the inability of the heart to supply sufficient blood flow meet the needs of the body

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Respiratory Failure

A

inadequate gas exchange by the respiratory system, resulting in arterial O2 and/or CO2 levels failing to be maintained in normal ranges

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Who’s Waiting for the “ECMO Train”?

A

Primary respiratory failure (neonatal)
Primary cardiac failure (all)
Primary respiratory failure (adults)
Primary respiratory failure (peds)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What causes Primary Respiratory Failure (Neonatal)

A

Meconium Aspiration
Sepsis
CDH (Congenital diaphragmatic hernia)
Persistent Pulmonary Hypertension (PPHN)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Increased PAP will lead to what?

A

Intrapulmonary shunting hypoxia and acidosis development

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

ELSO Neonatal ECMO Criteria: Indications

A

Oxygenation Index 20- consider ECLS

Oxygenation Index 40- ECLS indicated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Oxygenation Index Equation

A

(Mean Airway P x FiO2 x 100)/ Post ductal PaO2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What causes primary cardiac failure (Neonatal and Adult)

A 
Post-cardiotomy failure - unable to wean from CPB
Myocarditis
Cardiomyopathy
Cardiogenic shock
Sepsis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

ELSO Cardiac Criteria

A

Cardiac Index -5 x 3 hours (but less than 12 hrs)

Mean BP w/ oliguria: NB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Primary Respiratory Failure (Adults and Peds)

A 
ARDS
Pneumonia
Viral
Trauma
Primary graft failure following lung transplanation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

ELSO Pediatric Criteria (Indications)

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

ELSO Adult Respiratory Criteria

A

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% of greater

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

50% mortality risk can be identified by….

A

PaO2/FiO2 90% and/or Murray score 2-3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

80% mortality risk can be identified by…

A

PaO2/FiO2 90% and Murray score 3-4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Adult Respiratory Criteria

A

CO2 retention due to asthma or permissive hypercapnia with a PaCO2 > 80
Inability to achieve safe inflation pressures (Pplat = 30 cm HO) is an indication for ECLS
Severe air leak syndromes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Who else gets on ECMO?

A

Patients that don’t always fit the criteria

last resort maneuver

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Poor patient selection =

A

poor outcomes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Normal Techniques for ECMO Support

A

V-A
V-V
VV Dual Lumen (VVDL)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Modified Conversion Tehcniques

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is the first big question in ECMO?

A

what type of ecmo do i need?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Types of ECMO

A

Cardiac support
Respiratory support
Cardiac and respiratory support

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is the second big question in ECMO?

A

Peripheral

central

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Central vs Peripheral Cannulation: Advantages

A

Flow from Central ECMO is directly from the outflow cannula into the aorta provides antegrade flow to the arch vessels, coronaries and the rest of the body.

In contrast, the retrograde aortic flow provided by peripheral leads to mixing in the arch

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Central vs Peripheral Cannulation: Disadvantages

A

Previously insertion of central ECMO required leaving chest open to allow the cannula to exit.

Central cannula are costly (approx 4x times as much as peripheral)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What is the risk of leaving the chest open?

A

Increased risk of bleeding and infection

28
Q

How are the newer cannulas designed?

A

Newer cannula are designed to be tunneled through the subcostal abdominal wall allowing the chest to be completely closed

29
Q

Venoarterial (V-A) ECMO

A

venous blood is drained through a single lumen venous cannula, oxygenated, heated and return to patient via a single lumen arterial cannula

30
Q

What is the standard ECMO procedure used in most neonatal ICUs?

A

Veno-arterial bypass

31
Q

Why choose V-A ECMO?

A

Almost complete cardiopulmonary support

Allows significant cardiac and pulmonary rest

32
Q

Why NOT choose VA ECMO?

A 
Increases LV afterload
Lowers pulse pressure
Coronary oxygenation by LV blood
"Cardiac Stun"
Decreased cerebral autoregulation
neonatal carotid loss
33
Q

Pathological Processes Suitable for V-A ECMO (Common)

A

Cardiogenic shock
Post cardiac surgery
Drug overdose with profound cardiac depression
Myocarditis
Early graft failure: heart-lung transplant

34
Q

Pathological Processes Suitable for V-A ECMO (Other)

A 
pulmonary embolism
cardiac or major vessel trauma
pulmonary hemorrhage
pulmonary trauma
actue anaphylaxis
sepsis
bridge to transplant
35
Q

Venovenous ECMO

A

Venous blood is drained through a double lumen cannula, oxygenated, heated and returned to patient via holes in the distal ends of the cannula

36
Q

How are the cannulas placed in V-V EcMO?

A

In VV ECMO, a double-lumen cannula is placed through the right jugular vein into the right atrium

37
Q

How is blood circulating in V-V ECMO?

A

Desaturated blood is drawn from the RA, through the outer fenestrated venous catheter wall, and oxygenated blood is returned through the inner lumen of the catheter and is angled to direct blood across the TV

38
Q

How do you avoid mixing?

A

Cannula position

39
Q

V-V ECMO Diagnosis (Common)

A

Severe pneumonia
ARDS
ACute lung (graft) failure following transplant
pulmonary contusion

40
Q

V-V ECMO Diagnosis (Other)

A

Smoke inhalation
Status asthmaticus
Airway obstruction
Aspiration syndromes

41
Q

Common Cannulation Sites: VA

A

Right internal jugular vein (or femoral vein)

Right common carotid (axillary or aorta)

42
Q

Common Cannulation Sites: VV

A

Internal jugular vein alone; jugular-femoral, femoro-femoral or sapheno-saphenous veins or right atrium

43
Q

Usual Arterial PaO2 in VA vs VV

A

VA: 60-150 torr
VV: 45-80 torr

44
Q

Indicators of oxygen sufficiency: VA

A

Mixed venous saturation of PaO2

Calculated oxygen consumption

45
Q

Indicators of oxygen sufficiency: VV

A

combination of SaO2 or PaO2, cerebral venous saturation, and premembrane saturation trend

46
Q

Cardiac Effects: VA

A

Decreased preload; increased afterload

CVP varies, pulse pressure low, Coronary oxygenation provided by left ventricular blood. “Cardiac stun” syndrome

47
Q

Cardiac Stun Syndrome

A

Narrow pulse pressure and equal pt/circuit ABGs

48
Q

Cardiac Effects: VV

A

Negligible effects

CVP, pulse pressure unaffected. May improve coronary oxygenation. May reduce RV afterload

49
Q

Oxygen delivery capacity: VA

A

High

50
Q

oxygen delivery capacitiy: VV

A

Moderate. Improves with a cephalad drain

51
Q

Circulatory Support: VA

A

Partial to complete

52
Q

Circulatory Support: VV

A

No direct support, but increased oxygen delivery to coronary and pulmonary circulation can improve cardiac output

53
Q

Benefits of VA ECMO

A

Cardiac and respiratory support

54
Q

Benefits of VV ECMO

A 
preserves physiologic pulsatility
decrease for ischemic lung injury
thromboembolic enter pulmonary circulation
avoids ligation of carotid artery
may decrease risk of neurologic injury
55
Q

How does VV decrease risk of neurologic injury?

A

Blood entering cerebral arterial tree is less highly oxygenated and under less pressure

56
Q

Disadvantages of VA ECMO

A

ligation of carotid artery

lack of normal pulsatility

57
Q

Disadvantages of VV ECMO

A

decline in renal function during first 48 hours
Requirement of two site cannulation for larger patients
no direct circulatory support

58
Q

Recirculation

A

The shunting of arterial blood back into the venous lumen, common occurs during V-V ECMO and renders the monitoring of the venous line oxygen saturation no longer reflective of patient mixed venous oxygen saturation SvO2

59
Q

How do you know if theres more recirculation?

A

Higher SVO2

60
Q

Recirculation Fraction Calculation

A

R = [SO2 (preox) - SVO2 (pt)] / [SO2 (postox) - SvO2 (pt)]
R= recirculation factor %
SvO2 is the PATIENT not the venous line

61
Q

VA ECMO Flows

A

Neonate: 100-150 cc/kg/min
Pediatric: 75-100 cc/kg/min
Adult: 50-75 cc/kg/min

62
Q

VV ECMO Flows

A

Neonate: 100-120 cc/kg/min
Pediatric: 90-100 cc/kg/min
Adult: 75-90 cc/kg/min

63
Q

VV Conversion to VVA

A

Addition of an arterial cannula when you’re already on VV
Requires: “Y” venous lines of both arms of the dual lumen cannula or both venous lines to the single venous line to the pump
Cannulate artery and put the ECMO outflow line to it

in need of arterial support after VV cannulated: have ot come off bypass

64
Q

VA Conversion to VAV

A

In need of more venous return after V-A cannulated
start with V-A ECMO
need to add another venous to increased drainage

65
Q

VV conversion to VAV

A

addition of a venous cannula when youre already on VA
Requires: “Y”
Cannulated artery and put hte ECMO added to venous line and 2 venous cannulas not flow to the pump

ECMO (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions