ECMO (Extracorporeal Membrane Oxygenation ) AND CARDIO-PULMONARY BYPASS

When I think about Ecmo, I think

Introduction

Extracorporeal membrane oxygenation (ECMO) is an

extracorporeal technique of providing both cardiac and respiratory support oxygen to patients whose heart and lungs are so severely diseased or damaged that they can no longer serve their function
ECMO (extra corporeal membrane oxygenation) has become

more reliable with improving equipment, and increased experience, which is reflected in improving results.

Introduction

ECMO is instituted for the management of life

threatening pulmonary or cardiac failure (or both), when no other form of treatment has been or is likely to be successful.
ECMO is essentially a modification of the

cardiopulmonary bypass circuit which is used routinely in cardiac surgery.

Introduction

Instituted in an emergency or urgent situation after

failure of other treatment modalities.

It is used as temporary support, usually awaiting

recovery of organs.

Indications for ECMO

Divided into two type

Cardiac Failure Respiratory Failure

Indications Respiratory Failure

Adult respiratory distress syndrome (ARDS) Pneumonia Trauma. ECMO is also used for neonatal and pediatric

respiratory support

This is where most of the research on ECMO has been done

Configurations for ECMO

ECMO can be inserted in 2 configurations:

Veno-venous
Veno-arterial

 Veno-arterial (VA) configuration Blood being drained from the venous system and returned to the arterial system. Provides both cardiac and respiratory support. Achieved by either peripheral or central cannulation In veno-arterial ECMO a venous cannula is usually placed in the right common femoral vein for extraction and an arterial cannula is usually placed into the right femoral artery for infusion. The tip of the femoral venous cannula should be maintained near the junction of the inferior vena cava and right atrium, while the tip of the femoral arterial cannula is maintained in the iliac artery.[

Central ECMO Cannulation

 Veno-Venous (VV) configuration Provides oxygenation Blood being drained from venous system and returned to venous system. Only provides respiratory support Achieved by peripheral cannulation, usually of both femoral veins. n Veno-venous ECMO venous cannulae are usually placed in the right common femoral vein for drainage and right internal jugular vein for infusion

Peripheral ECMO Cannulation

FILM OXYGENATORS
The initial clinical units are described as film oxygenators

because a rotating cylinder was used to generate a large, thin film of blood on the cylinder surface where it contacted the exchange gas . Although effective, these early film oxygenators suffered from a number of failings that eventually led to their replacement. The direct gas-blood interface allowed for adequate gas exchange but extensive cellular damage and protein denaturation resulted from the blood-gas interface. The time-consuming, complicated maintenancE were its disadvantages.

BUBBLE OXYGENATORS
Direct gas-blood contact remained in bubble

oxygenators, but the large surface area of the dispersed oxygen bubbles resulted in greater mass transfer . In addition, these devices were simple and disposable, consisting of a bubbling chamber, defoaming unit, and a return arterial reservoir . However, the blood damage seen with film oxygenators was not corrected with the new bubbling technology, and concerns regarding blood trauma during longer perfusions

 The use of a semipermeable membrane to separate the

blood and gas phases characterizes all membrane oxygenator designs. Membrane oxygenators can be further divided into flat sheet/spiral wound andhollow fiber models. The flat sheet designs restrict blood flow to a conduit formed between two membranes with gas flowing on the membrane exterior; these systems were the first membrane oxygenators to enter use . Spiral wound oxygenators use membrane sheets as well but are arranged in a roll rather than the sandwich formation of the original flat sheet assemblies. Polymers such as polyethylene, cellulose and polytetrafluoroethylene were used for membranes