ECMO extracorporeal membrane oxygenation
- related: Cardiology, ICU intensive care unit
- tags: #literature #cardiology
VA ECMO
- retrograde blood flow delivered up femoral artery and illiac system is increasing afterload against which LV has to pump
- adding strain to already strained ventricle
- If ventricle still have contractility, can fight against ECMO circuit
- NS syndrome: blood going to brain is less oxygenated than blood going to distal peripheral
- ecmo and LA venting
- strategies to unload LV to help with pumping1
- ECMO patients are harder to sedate and harder to wake up because of lipophilic circuit?
- bivalrudin is better than heparin for VV ECMO?
- no 10a levels for bival as it’s 2a direct
- chattering in ecmo circuit indicates low volume?
- increased delta P is sign of increased clotting on ECMO
- ECMO does not show decrease in 60 day mortality for ARDS patients
- use low TV and FiO2 on ventilator for ECMO patients
- Use RESP Score to calculate mortality
- Sweep is amount of CO2 removal
- Flow is PEEP/FiO2
- initiate VV ecmo when P:F < 150 or P:F < 80, refractory hypoxemia or hypercapnia
- Use RESP score
- bronchopleural fistula, ARDS, obstruction
- Use Va ecmo for refractory cardiogenic shock or cardiac arrest
- PE, overdose
- use SAVE score
- cannula size: use vessel mm x 3 = French size
- flowneeds: 60-80 cc/kg/min
- ECMO recirculation happens when there is less than 10 cm distance
- ECMO use bilateral arterial line to rule out north south syndrome?
- right arterial line true oxygenation
- ECMO bias flow on ventilator for low TV alarm
- left: centrifugal pump. Blood comes in middle and spun outward
- right: roller pump propels blood forward
- N-S syndrome: mixture of blood from heart and from pump
- put pulse ox on right hand because the right side will have least amount of good O2
- if heart doesn’t pump at all, then flow from pump will make heart more distended over time
- complications: everyone is going to bleed and have clots
- limb ischemia
- bleeding: head bleeds, major bleeds
- neurologic insults
- mechanical failure
To learn
- ecmo insertion site
- PROTEC ecmo
- MCS vs ECMO