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 |
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 |
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 |
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