Você está na página 1de 24

ECMO

ECMO By Cindy Baurax Jessica Hugdahl Marivel Rios Vali Sollock

By Cindy Baurax

Jessica Hugdahl

Marivel Rios

Vali Sollock

Biological Question

  • Does ECMO provide life support in

severe respiratory failure by

allowing time for injured lungs to recover?

Biological Question  Does ECMO provide life support in severe respiratory failure by allowing time for

Hypothesis

  • The selective use of ECMO for acute

respiratory failure will increase

survival rates over conventional mechanical ventilation.

Hypothesis  The selective use of ECMO for acute respiratory failure will increase survival rates over
  • ECMO which is Extra-corporeal membrane oxygenation, is a

temporary life support system used for patients who have failed

traditional mechanical ventilation.

 ECMO which is Extra-corporeal membrane oxygenation, is a temporary life support system used for patients

INDICATIONS

  • The need for ECMO is when a

patient who has received

appropriate medical management has:

  • a PaO2 of 50-60mmHg, when the PIP

is >35cmH20

  • FiO2 is 100% for conventional ventilation

  • without improvement of oxygenation while on high frequency ventilation over a six hour period.

Patient Selection

Patient Selection

Patient Selection
  • Limiting the duration of ECMO to <30 days

due to increased risks of complications after approximately

fourteen days of therapy.

 Limiting the duration of ECMO to <30 days due to increased risks of complications after

TWO TYPES OF ECMO:

  • Veno-arterial bypass - supports the

heart and lungs

  • Requires two cannulae-one in jugular vein and one in the carotid artery

  • Veno-venous bypass supports the lungs only

    • Requires one cannula- jugular vein

Link to Picture of ECMO tubing when connected to

patient

POTENTIAL RISKS

  • Insertion of a tube into a blood vessel has an increased risk of infection.

  • Brain damage from head bleed

  • Surgical site bleeding

  • Pneumothorax

  • Hypertension

  • Cardiac Dysrhythmias

  • Abnormal creatin and bilirubin values

  • Intraventricular hemorrhage

  • Air in circuit

  • Pump malfunction

  • Clots in the circuits

  • Pump malfunction

  • Heat exchanger malfuntion

Potential Benefits

  • Being on ECMO will rest the lungs

and heart so that there is an

increased survival rate.

Potential Benefits  Being on ECMO will rest the lungs and heart so that there is

CONTRAINDICATIONS

  • Intracerebral hemorrhage

  • Severe brain damage

  • Multiple congenital anomalies

  • Irreversible brain damage

  • Weight <2.0Kg

  • Necrotizing Pneumonia

  • Multiple organ failure

  • Metastatic disease

  • Major CNS injury

  • Gestational age <34 weeks

  • Overwhelming Sepsis

  • Parental Refusal

TREATMENT FOR CHILDREN:

  • Hyaline membrane disease

  • Meconium Aspiration

  • Persistant Fetal Circulation

  • Congenital Diaphragmatic Hernia

  • Cardiac Anomalies

TREATMENT FOR CHILDREN:  Hyaline membrane disease  Meconium Aspiration  Persistant Fetal Circulation  Congenital

TREATMENT FOR ADULTS:

  • Adult Respiratory Distress

Syndrome (ARDS)

  • Non-necrotizing pneumonias

  • Pulmonary contusion

  • Other reversible respiratory and cardiac failure not responsive to other measures

  • Post cardiac surgery

Preliminary Diagnostic Studies:

  • Head Ultrasound

  • Coagulation Status

  • Platelet Count

Preliminary Diagnostic Studies:  Head Ultrasound  Coagulation Status  Platelet Count  Calcium and Electrolyte
  • Calcium and Electrolyte levels

  • White Blood Cell Count

  • Hemoglobin and Hematocrit levels

  • Blood type and Cross

Weaning Parameters:

  • A trial period without ECMO when the patient demonstrates adequate

gas exchange and is on reasonable

ventilator settings and tolerates a

pump flow of 10-20mL/kg/min with

the minimum of 200 mL/min.

Weaning Parameters:  A trial period without ECMO when the patient demonstrates adequate gas exchange and
METHODOLOGY  STUDY #1  This study involved 128 neonates on ECMO from October 1985 to

METHODOLOGY

  • STUDY #1

    • This study involved 128 neonates on ECMO from October 1985 to September 1998. Patients had either severe acute hypoxemic respiratory failure or severe acute hypercarbic respiratory failure unresponsive to maximal conventional management. Inclusion criteria

P/F ratio < or = 100 or refractory hypercarbia

with ph < or = 7.0.

Each subject’s parents

were given a consent form explaining the

procedure.

  • The data collected in this study were lung compliance that was dividend of the tidal volume and the difference between the end

inspiratory pressure and PEEP.

  • Study #2

    • This study involved 50 adult patients (older than 16 years old) between the years 1989 and 1995 with refractory respiratory failure. Patients who had contraindications to ECMO were not eligible for this study. Each subject was given a consent form explaining the procedure.

    • The data collected in the study was: P/F ratio, PIP, PEEP and the time ventilated.

 Study #2  This study involved 50 adult patients (older than 16 years old) between

Methodology Instruments Used

  • Study #1- ECMO machine

  • Study #2- Two membrane lungs (ultrox1) with integral heat exchangers are arranged in parallel with counter current gas flow; 100% oxygen is used as the sweep gas. Roller pumps (Stockert) with Seabrook bladder box servo control are used. Blood raceway tubing is Tygon S- 65HL (Norton Performance Plastics). Heaters (Cincinnati Sub-Zero) are used to maintain normothermia.

Statistics

 

Study #2

Average

 

Study #1 MEAN

MEAN

Mean

Pre ECMO time ventilated (days)

4.7

3.19

3.95

PIP cmH2O

25

39.6

32.3

PEEP cmH2O

5

10

7.5

P/F ratio mmHg

58

65

61.5

Survival Rate (days)

58%

66%

62%

Discussion

Discussion  Patients with respiratory failure usually respond favorably to various forms of mechanical ventilation with
Discussion  Patients with respiratory failure usually respond favorably to various forms of mechanical ventilation with
  • Patients with respiratory failure usually respond favorably to various forms of mechanical ventilation with PEEP, permissive hypercapnia, and inhalation pulmonary vasodilators. Using these methods, survival rates > 60% have been

documented. There remains, however, a

small number of patients with respiratory failure whose pulmonary gas exchange cannot be improved by the above mentioned methods. ECMO may be a

therapeutic option during the acute phase

of the disease.

Recommendations

Recommendations  These studies were done on patients who failed conventional mechanical ventilation. In the past
  • These studies were done on

patients who failed conventional

mechanical ventilation. In the past few years the use of ECMO as a

therapeutic option has been

usurped by high frequency oscillation ventilation with the addition of inhalation nitric oxide.

Continued

  • Further studies should be done on patients that fail these more advanced

options and retain a PaO2 <50mmHg for

>2 hours at FiO2 100% and PEEP >5cmH2O. These studies will test the absolute effectiveness of ECMO. If the

survival rates in this group are not

significantly greater than the high frequency oscillation plus inhaled nitric oxide, the use of the expensive and invasive procedure of ECMO may no

longer be warranted.

Continued  Further studies should be done on patients that fail these more advanced options and

References

  • Swankiker, F., Kolla, S., Moler, F., Custer, J., Grams, R., Bartlett, R., Hirschl, R. (2000). Extracorporeal Life Support Outcome for 128 Pediatric Patients With Respiratory Failure. Journal of Pediatric Surgery, 35, 197- 202. Abstract obtained July 8, 2006, from Google at www.google.com

  • Peek, G., Moore, H., Moore, N., Sosnowski, A., Firmin, R.(1997). Extracorporeal Membrane Oxygenation for Adult Respiratory Failure. Chest, 112, 759-764. Abstract obtained July 8, 2006, from Google at www.google.com

References  Swankiker, F., Kolla, S., Moler, F., Custer, J., Grams, R., Bartlett, R., Hirschl, R.g er y , 35, 197- 202. Abstract obtained July 8, 2006, from Google at www.google.com  Peek, G., Moore, H., Moore, N., Sosnowski, A., Firmin, R.(1997). Extracorporeal Membrane Oxygenation for Adult Respiratory Failure. Chest, 112, 759-764. Abstract obtained July 8, 2006, from Google at www.google.com " id="pdf-obj-23-20" src="pdf-obj-23-20.jpg">