o Extra o Corporeal o Membrane o Oxygenation

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Wiktor Żurek
7 lat temu
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1 Kiedy żylno-żylne ECMO, a kiedy żylno tętnicze? o Extra o Corporeal o Membrane o Oxygenation Szymon Pawlak

2 Why should we do ECMO?

4 Types of ECMO o ECMO V-V veno venous Cannulation of jugular and femoral vein or use of double lumen cannula o ECMO V-A veno arterial Cannulation of jugular and/or femoral vein and femoral artery

5 Comparison of ECMO venoarterial venovenous po mmhg mmhg cardiac effect oxygen delivery circulatory support decreased preload increased afterload high partial to complete negligible effects may reduce RV afterload moderate no direct effect R-L shunt decrease saturation increase saturation

6 Indications o V-V venovenous Extreme respiratory failure not responding for conventional methods of treatment, caused by reversible sickness process o V-A venoarterial Circullatory support, biventricullar insufficiency

7 Indications for venovenous ECMO 1. MAS - Meconium Aspiration Syndrome 2. PPHN - Persistent pulmonary hypertension of the newborn 3. ARDS - Acute Respiratory Distress Syndrome 4. Congenital pneumonia 5. Congenital diaphragmatic hernia 6. Persistent fetal circulation 7. Status asthmaticus 8. ECMO as bridge to transplantation

8 Contraindications for ECMO o Irreversible diseases of respiratory system, o Contraindications for heparynization, o Bleeding, o Anticipation of lack of correction, o No agreement for treatment.

9 Parameters of qualifications for ECMO o Deterioration of state with acidosis and shock o Pa0 2 od 30 do 40 mm Hg, ph <7,25 for 2 hours, or hypoxemia with hypotension, o Pa0 2 <35 for 2, or<50 mm Hg for 6 h, o Oxygenation index 0I > 60 for ½ h, or 0I > 35 for 6h o Alveolar-arterial oxygen difference AaD0 2 > 620 mm Hg for 4 h, or > 605 mm Hg for 12 h

$airway pressure arterial oxygen partial pressure fraction of inspired oxygen in a gas$

10 Oxygenation index (OI) = ( MAP x Fi0 2 x 100) : Pa0 2 o MAP o Pa0 2 o Fi0 2 Mean airway pressure arterial oxygen partial pressure fraction of inspired oxygen in a gas mixture

11 Alveolar-arterial oxygen difference AaD0 2 = PA0 2 Pa0 2 PA0 2 = Fi0 2 (PB P H 2 0) 1,25 PAC0 2 Simplified account for ECMO: AaD0 2 = PB 47 PaC0 2 Pa0 2 o PA0 2 o Pa0 2 o Fi0 2 o PB o PH 2 0 o PAC0 2 alveolar oxygen partial pressure arterial oxygen partial pressure fraction of inspired oxygen in a gas mixture barometric pressure vapor pressure carbon dioxide pressure

o Sedation (morphin-midasolam, phentanyl-pancuronium, others) o Examination:

12 Starting the procedure o anticoagulation (heparynization - ACT ~200) o Blood components (RBC, FFP, platelets under control of morphology) o Antybiotykotherapy o Sedation (morphin-midasolam, phentanyl-pancuronium, others) o Examination: Gasometry every 4 hours ACT every 12 hours, chest X-rays, USG, bacteriology, others every day

13 o Use TEE to check cannula position for adult patients and jugular - femoral access or UKG to check double lumen canuula for children Cannulation o use sugical access to put in double lumen cannula

14 ECMO pumps and oxygenators

15 Mechanical ventiltion o Respiratory parameters ( resting pulmonary parameters FiO 2 30%, PEEP +10 cm H 2 O, PIP +10 cm H 2 O, BPM 10/min) o Respiratory care ( intensive treatment of respiratory tract, rehabilitation, aspiration, bronchoscopy )

16 oproblems with hemostasis, hematoma formation, bleeding into the CNS, osepsis, osignificant hemolysis and its consequences, oarrhythmias, Complications opresence of air bubbles in the tubing system oblood clotting in cannula, tubing system, oxygenator, odamage to the heat exchanger oaccidental decannulation

17 othe only true indicator that a run is coming to an end is the return of adequate pulmonary and cardiac function. othree issues Weaning the ECMO 1 - What are the risks of continuing ECMO? 2 - What are the risks of coming of ECMO, and what support measures and ventilator settings will be required to maintain the patient of bypass? 3 - What degree of support is acceptable by the team to get the patient off the bypass?

18 Thank You For Your Attention

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