Difference between revisions of "Extracorporeal membrane oxygenation"

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==Overview==
 
==Overview==
 +
*Abbreviation: ECMO
 +
**Extracorporeal life support (ECLS) becoming a more common term
 +
*Extracorporeal circuit that oxygenates blood and removes carbon dioxide (functions as an out-of-body lung)
 +
**Can be high flow or low flow
 +
*Similar (but not identical) to cardiopulmonary bypass machine
 +
**Requires lower levels of anticoagulation and allows longer duration of treatment (time on pump)
 +
*Emerging therapy in Emergency Medicine (eCPR) but not yet well studied in this context
  
 +
===Types===
 +
*Veno-venous (VV)
 +
**Most common
 +
**Blood drained from central vein → oxygenator → vein near RA
 +
**Supports severe respiratory failure without cardiac dysfunction
 +
*Veno-arterial (VA): can be peripheral or central
 +
**Blood drained from central vein → oxygenator → aorta
 +
**Supports cardiac failure with or without respiratory failure
 +
*Veno-pulmonary artery
 +
**Blood drained from central vein → oxygenator → pulmonary artery
 +
**Short term right ventricular/respiratory support after LVAD placement
 +
*Hybrid (VVA or VAV)
  
 
==Indications==
 
==Indications==
 
+
*Acute, severe respiratory or cardiac failure + REVERSIBLE cause + refractory to usual treatment + high risk of death
 +
**Poor gas exchange
 +
**Compliance < 0.5ml/cmH20/kg
 +
**P:F Ratio <100
 +
**Shunt fraction >30%
 +
*Veno-venous (VV)
 +
**[[Pneumonia]], [[ARDS]], acute [[GVHD]], [[pulmonary contusion]], smoke inhalation, status asthmaticus, airway obstruction, drowning, bridge to lung transplant
 +
*Veno-arterial (VA)
 +
**Massive PE, nonischemic cardiogenic shock, failure of transplanted heart or heart-lung, cardiac or great vessel trauma, massive pulmonary hemorrhage/trauma, sepsis, anaphylaxis, drug overdose, bridge to LVAD
  
 
==Contraindications==
 
==Contraindications==
 
+
*Absolute
 +
**>120 kg
 +
**unwitnessed cardiac arrest
 +
**non-reversible, progressive cardiac disease in a patient who is not a transplant candidate
 +
**non-reversible, progressive respiratory disease
 +
**severe, chronic pulmonary hypertension
 +
**advanced cancer
 +
*Relative
 +
**older than 75 years
 +
**multisystem trauma
 +
**CNS injury
 +
**multiple organ failure
 +
*VV
 +
**unsupported cardiac failure, cardiac arrest, severe pulmonary hypertension, significant immunosupression
 +
*VA
 +
**Aortic dissection or severe aortic regurgitation
  
 
==Equipment Needed==
 
==Equipment Needed==
Line 15: Line 57:
  
 
==Complications==
 
==Complications==
 
+
*Clot formation
 +
*Bleeding
 +
*Suck down and kicking (vessel collapse around access cannula)
 +
*Circut rupture, deccannulation, oxygenator failure, pump failure
 +
*VA can → left ventricle overdistension → cardiac damage, pulmonary bleed or infarction, aortic thrombosis, cardiac or cerebral hypoxia
 +
*North-South syndrome (cephalad hypoxia/cyanosis) may occur in patients with femoral-femoral cannulation for VA support
  
 
==See Also==
 
==See Also==
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==External Links==
 
==External Links==
 
+
*[http://www.elso.org Extracorporeal Life Support Organization (ELSO)]
 +
*[http://www.edecmo.org ED ECMO Podcast]
  
 
==References==
 
==References==
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[[Category:Procedures]]
 
[[Category:Procedures]]
 +
[[Category:Critical Care]]

Latest revision as of 16:10, 9 October 2019

Overview

  • Abbreviation: ECMO
    • Extracorporeal life support (ECLS) becoming a more common term
  • Extracorporeal circuit that oxygenates blood and removes carbon dioxide (functions as an out-of-body lung)
    • Can be high flow or low flow
  • Similar (but not identical) to cardiopulmonary bypass machine
    • Requires lower levels of anticoagulation and allows longer duration of treatment (time on pump)
  • Emerging therapy in Emergency Medicine (eCPR) but not yet well studied in this context

Types

  • Veno-venous (VV)
    • Most common
    • Blood drained from central vein → oxygenator → vein near RA
    • Supports severe respiratory failure without cardiac dysfunction
  • Veno-arterial (VA): can be peripheral or central
    • Blood drained from central vein → oxygenator → aorta
    • Supports cardiac failure with or without respiratory failure
  • Veno-pulmonary artery
    • Blood drained from central vein → oxygenator → pulmonary artery
    • Short term right ventricular/respiratory support after LVAD placement
  • Hybrid (VVA or VAV)

Indications

  • Acute, severe respiratory or cardiac failure + REVERSIBLE cause + refractory to usual treatment + high risk of death
    • Poor gas exchange
    • Compliance < 0.5ml/cmH20/kg
    • P:F Ratio <100
    • Shunt fraction >30%
  • Veno-venous (VV)
  • Veno-arterial (VA)
    • Massive PE, nonischemic cardiogenic shock, failure of transplanted heart or heart-lung, cardiac or great vessel trauma, massive pulmonary hemorrhage/trauma, sepsis, anaphylaxis, drug overdose, bridge to LVAD

Contraindications

  • Absolute
    • >120 kg
    • unwitnessed cardiac arrest
    • non-reversible, progressive cardiac disease in a patient who is not a transplant candidate
    • non-reversible, progressive respiratory disease
    • severe, chronic pulmonary hypertension
    • advanced cancer
  • Relative
    • older than 75 years
    • multisystem trauma
    • CNS injury
    • multiple organ failure
  • VV
    • unsupported cardiac failure, cardiac arrest, severe pulmonary hypertension, significant immunosupression
  • VA
    • Aortic dissection or severe aortic regurgitation

Equipment Needed

Procedure

Complications

  • Clot formation
  • Bleeding
  • Suck down and kicking (vessel collapse around access cannula)
  • Circut rupture, deccannulation, oxygenator failure, pump failure
  • VA can → left ventricle overdistension → cardiac damage, pulmonary bleed or infarction, aortic thrombosis, cardiac or cerebral hypoxia
  • North-South syndrome (cephalad hypoxia/cyanosis) may occur in patients with femoral-femoral cannulation for VA support

See Also

External Links

References