Extracorporeal Membrane Oxygenation (ECMO) - Basics Mode of cardiopulmonary support used to treat pulmonary and/or cardiovascular failure with an external artificial circuit ECMO GOALS: • Maintain adequate tissue oxygenation to allow recovery from potentially reversible cardiopulmonary failure • Adjust ventilator settings with very low tidal volumes, allowing for lung rest, minimizing further ventilator-induced lung injury • ECMO is a bridge, not a destination Veno-Arterial (VA) • Supports heart and lungs (complete cardiopulmonary support) • Blood drains - venous system • Blood returns - arterial system Veno-Venous (VV) • Suppots lungs (pulmonary support only) • Blood drains - venous system • Blood returns - venous system E-CPR • Rapid deployment of VA-ECMO when CPR is unsuccessful in achieving sustained return of spontaneous circulation PARAMETERS Flow (mL/kg/min): • Dial in RPMs and flow depends on resistance in patient & circuit • Generally set between 4-6 Lmin (100-150 mL/kg/min in children) • On VA-ECMO - flow supports cardiac output • On VV-ECMO - flow supports oxygenation Sweep (L/min): Sweep gas flow determines PCO2 clearance (ie, ventilation) for both VV- & VA-ECMO OXYGEN DELIVERY • From both lungs & oxygenator • Assess perfusion (eg, NIRS, SVO2, lactate) REST SETTINGS • If ventilated, frequently placed on low "rest" settings with moderate PEEP • Bronchoscopy may be needed for plugging ANTICOAGULATION • To reduce risk of thromboembolism in circuit • Done per institutional protocol ELECTROLYTE REPLACEMENT • Particularly Ca+ due to citrate binding #Extracorporeal #Membrane #Oxygenation #ECMO #Basics #management #pulmonary #criticalcare
