ECMO extracorporeal membrane oxygenation extracorporal life support 2010/9/22 Presented by Nai-Hsin Chi National Taiwan University Hospital
ECMO prolonged partial cardiopulmonary bypass
ECMO vs CPB • reservoir
CPB vs ECMO Yes in high flow
composite of ECMO • Blood pump centrifugal pump roller pump+ control-bladder • membrane oxygenator hollow fiber oxygenator silicone membrane oxygenator • Heater
ECMO 機器
ECMO主機
Centrifugal pump
滾輪式幫浦加囊狀控制裝置
Pig-Tail 排氣用 接氧氣
Cannula
Arterial cannula
MX-2 monitor
氣體流量表
ECMO • Short-term cardiopulmonary support 1 -2 weeks • Bridge to decision Buy time to decide the next step – Recovery – Transplantation – long-term device (ventricular assist device) – Operation (CABG, pulmonary embolectomy, . . ) – Give-up
for lung 1. support : O 2 supply & CO 2 removal 2. rest : reduce ventilator induced lung injury
for heart support : improve systemic perfusion rest : ↓catecholamine ↓myocardial work decrease preload requirement and congestion
ECMO Type • VV - ECMO • VA - ECMO
VV-ECMO indication : for lung disease only purpose : to decrease barotrauma ventilator setting : PC mode, PEEP >10 , PIP < 35 , VR --> Pa. CO 2, Fi. O 2 --> Pa. O 2
VA-ECMO advantage : 1. both lung & heart support
Application of ECMO • As a mechanical circulatory support: – – – Post-cardiotomy cardiogenic shock Double bridge (ECMO VAD HTx) Acute myocarditis AMI cardiogenic shock (ECPR) Rescue for acute pulmonary embolism • Ventilatory support – ARDS – Neonatal pulmonary diseases
Different patients Different situation Different treatment • t
ECMO in NTUH 1994 Aug. 11 2003 Dec. 31
ECMO 作車 All you need to set up ECMO Put everything on the wheel Then, OR, ICU, cath room, ES, ward, etc
Bleeding Anticoagulation Thrombus
尿紅
Five-Year Results of 219 Consecutive Patients Treated With Extracorporeal Membrane Oxygenation for Refractory Postoperative Cardiogenic Shock Ann Thorac Surg 2004; 77: 151 -7
Results 86 (39%) did not improved and weaning 133 (61%) successfully weaned from ECMO Mortality Cause : Refractory myocardial failure : 118(71%) Mo. F : 24(14%) Cerebral infarction/bleeding : 8(5%) Sepsis : 6(4%) ARDS: 4(2. 5%) DIC : 2(1%) Bowel ischemia : 2(1%) Pulmonary embolism: 2(1%) ET tube into esophagus : 1(0. 5%) 52 (39%) discharge Mean hospital stay: 29. 9 24 days
Bridge VAD : 8 Transplant : 4 survival Heart. Mart : 2 Heart Transplant : Survival Berlin Heart : 6 (Biventricular : 4, Univentricular : 2) Successfully weaning : 1 Die : 5
ECMO • Short-term cardiopulmonary support 1 -2 weeks • Bridge to decision Buy time to decide the next step – Recovery – Transplantation – long-term device (ventricular assist device) – Operation (CABG, pulmonary embolectomy, . . ) – Give-up
ECMO Advantage: 1. Both children & adult (wide range of BW) 2. Flexible cannulation site: femoral, neck, chest 3. Higher support 4. Rapid & easy set-up & remoral Disadvantage: 1. Bleeding 2. Bedridden 3. Infection 4. SIRS 5. Labor-intensive 6. Partial CP support
Thank you
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