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

Demographics

ECMO does not show decrease in 60 day mortality for ARDS patients
Use RESP Score to calculate mortality
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

Physiology

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
use low TV and FiO2 on ventilator 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

Complications and Troubleshoot

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
complications: everyone is going to bleed and have clots
- limb ischemia
- bleeding: head bleeds, major bleeds
- neurologic insults
- mechanical failure

²

To learn

ecmo insertion site
PROTEC ecmo
MCS vs ECMO

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