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ECMO - PowerPoint PPT Presentation


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ECMO. Extra Corporeal Membrane Oxygenation. ECMO Indications. Acute, reversible lung and/or cardiac failure that is unresponsive to conventional therapies Gestational age: 34 weeks or > Weight: 2000 grams or > Predicted mortality: 80% or > A-a gradient (on 100% FIO2): 620 mmhg or >

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ECMO

Extra Corporeal Membrane Oxygenation

ecmo indications
ECMO Indications
  • Acute, reversible lung and/or cardiac failure that is unresponsive to conventional therapies
  • Gestational age: 34 weeks or >
  • Weight: 2000 grams or >
  • Predicted mortality: 80% or >
    • A-a gradient (on 100% FIO2): 620 mmhg or >
    • Oxygen Index (OI): 40 or >
      • OI = (MAP x FIO2) x 100

PaO2

ecmo techniques
ECMO Techniques

Venoarterial

  • Complete cardiopulmonary bypass
  • Out: Right atrium via internal jugular
  • In: Aortic arch via carotid
  • Requires ligation of one carotid artery!
ecmo techniques con t
ECMO Techniques (cont.)

Venovenous

  • Out: right atrium via internal jugular
  • In: right atrium via femoral vein
    • Is a lung bypass only technique
  • No ligation of carotid artery
  • Newer circuits have a dual lumen catheter so in/out is in right atrium via one vein only
ecmo management
ECMO Management
  • Circuit must be heparinized, so bleeding potential exists
  • CO2 may need to be added to blood after it passes through membrane gas exchanger
  • 80% of cardiac output may initially be bypassed
  • Patient is weaned to 10% bypass (20 ml/kg/min)
  • SvO2 is maintained at 75%
  • Infant is kept on low PIP, PEEP, Rate, and FIO2 while on ECMO