ECMO

 

How does it work:

Components

      Draining cannula

      Pump

      Membrane oxygenator

      Return cannula

Types

Common:

      VV (lung bypass)

      VA (heart + lung bypass)

Uncommon:

      VAV

      VVA

      VPA (with LVAD)

Workflow

      Insertion: OT if central, ICU if peripheral

      Maintenance: need protocols

      Weaning: ensure heart and lungs are working properly

      Decannulation: OT if central, ICU if peripheral

 

Decision making:

Indications

Cardiac:

      Cardiac arrest

      Failure to wean from CPB

      Fulminant myocarditis

      Acute cardiomyopathy e.g. peri-partum

      Pulmonary embolism

      Toxidromes

      Heart transplant failure

Respiratory:

      ARDS e.g. flu

      Lung transplant failure

      Pulmonary vasculitis

      Pulmonary haemorrhage

Contraindications

      Advanced age

      Severe comorbidities

      Acute multi-organ failure

 

Complications:

Body

      Bleeding (brain, cannula sites)

      Thrombosis

      Embolism (brain, gut, limb)

      Infection

      Vessel injury

      Limb ischaemia (peripheral VA)

      Differential hypoxia (central VA)

o  Central VA ECMO only

o  Branches of proximal aorta get blue blood

o  Put sats probe on the right hand

Machinery

      Access insufficiency (e.g. against vessel wall)

      Accidental decannulation

      Draining circuit breach -> air embolism

      Return circuit breach -> bleeding

      Oxygenator failure (accumulation of fibrin etc)

      Pump failure

Drugs

      Large increase in central volume of distribution

      Oxygenator sequesters lipophilic, highly protein-bound drugs

      Risk of both inefficacy and toxicity

      Careful with a) anaesthetic b) vasopressor c) anticoagulant

 

 

Feedback welcome at ketaminenightmares@gmail.com