ECMO extracorporeal membrane oxygenation
- related: Cardiology and Hemodynamics, ICU intensive care unit, cardiac supportive devices
- tags: #literature #cardiology, #icu
Demographics
- ECMO when to initiate or refer
- ECMO does not show decrease in 60 day mortality for ARDS patients
- ECMO has no effect on survival benefit in shock patients
Types
Sedation
Physiology
- ECMO patients are harder to sedate and harder to wake up because of lipophilic circuit?
- ECMO anticoagulation with bivalrudin or heparin
- use resting ventilator support for ECMO patients
- Sweep is amount of CO2 removal
- Flow is PEEP/FiO2
- cannula size: use vessel mm x 3 = French size
- flow needs: 60-80 cc/kg/min
- use mixed venous oxygen to guide blood transfusion in ECMO
Complications and Troubleshoot
- Circuit Flow problems
- Recirculation problems
- Blood O2 problems
- Bleeding/clotting problems
- everyone is going to bleed and have clots
- limb ischemia
- bleeding: head bleeds, major bleeds
- neurologic insults
- mechanical failure
- LV overdistension in ECMO and unloading strategies
- ECMO bias flow on ventilator for low TV alarm
Liberation from ECMO
To learn
- PROTEC ecmo
- MCS vs ECMO