Extracorporeal membrane oxygenation

Revision as of 18:57, 8 September 2016 by ClaireLewis (talk | contribs) (Complications)

Overview

  • aka ECMO
  • Extracorporeal circuit, oxygenates blood and removes carbon dioxide, like an out-of-body lung
    • Can be high flow (1 venous line) or low flow (1 venous line)
  • 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

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: left ventricle overdistension--> cardiac damage, pulmonary bleed or infarction, aortic thrombosis, cardiac or cerebral hypoxia

See Also

External Links

References