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12. the ecmo simulator #beach2019 (malbrain) Slide 1 12. the ecmo simulator #beach2019 (malbrain) Slide 2 12. the ecmo simulator #beach2019 (malbrain) Slide 3 12. the ecmo simulator #beach2019 (malbrain) Slide 4 12. the ecmo simulator #beach2019 (malbrain) Slide 5 12. the ecmo simulator #beach2019 (malbrain) Slide 6 12. the ecmo simulator #beach2019 (malbrain) Slide 7 12. the ecmo simulator #beach2019 (malbrain) Slide 8 12. the ecmo simulator #beach2019 (malbrain) Slide 9 12. the ecmo simulator #beach2019 (malbrain) Slide 10 12. the ecmo simulator #beach2019 (malbrain) Slide 11 12. the ecmo simulator #beach2019 (malbrain) Slide 12 12. the ecmo simulator #beach2019 (malbrain) Slide 13 12. the ecmo simulator #beach2019 (malbrain) Slide 14 12. the ecmo simulator #beach2019 (malbrain) Slide 15 12. the ecmo simulator #beach2019 (malbrain) Slide 16 12. the ecmo simulator #beach2019 (malbrain) Slide 17 12. the ecmo simulator #beach2019 (malbrain) Slide 18 12. the ecmo simulator #beach2019 (malbrain) Slide 19 12. the ecmo simulator #beach2019 (malbrain) Slide 20 12. the ecmo simulator #beach2019 (malbrain) Slide 21 12. the ecmo simulator #beach2019 (malbrain) Slide 22 12. the ecmo simulator #beach2019 (malbrain) Slide 23 12. the ecmo simulator #beach2019 (malbrain) Slide 24 12. the ecmo simulator #beach2019 (malbrain) Slide 25 12. the ecmo simulator #beach2019 (malbrain) Slide 26 12. the ecmo simulator #beach2019 (malbrain) Slide 27 12. the ecmo simulator #beach2019 (malbrain) Slide 28 12. the ecmo simulator #beach2019 (malbrain) Slide 29 12. the ecmo simulator #beach2019 (malbrain) Slide 30 12. the ecmo simulator #beach2019 (malbrain) Slide 31 12. the ecmo simulator #beach2019 (malbrain) Slide 32 12. the ecmo simulator #beach2019 (malbrain) Slide 33 12. the ecmo simulator #beach2019 (malbrain) Slide 34 12. the ecmo simulator #beach2019 (malbrain) Slide 35 12. the ecmo simulator #beach2019 (malbrain) Slide 36 12. the ecmo simulator #beach2019 (malbrain) Slide 37 12. the ecmo simulator #beach2019 (malbrain) Slide 38 12. the ecmo simulator #beach2019 (malbrain) Slide 39 12. the ecmo simulator #beach2019 (malbrain) Slide 40 12. the ecmo simulator #beach2019 (malbrain) Slide 41 12. the ecmo simulator #beach2019 (malbrain) Slide 42 12. the ecmo simulator #beach2019 (malbrain) Slide 43 12. the ecmo simulator #beach2019 (malbrain) Slide 44 12. the ecmo simulator #beach2019 (malbrain) Slide 45 12. the ecmo simulator #beach2019 (malbrain) Slide 46
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This workshop will outline the basic principles of extracorporeal life support made easy by key-experts in the field. During the course delegates will gain a good understanding of ECMO in the following areas: Theoretical concepts, basic physiology and pathophysiology, cardiac and respiratory support and monitoring, alarm settings and monitoring, role of cardiac ultrasound during ECMO, newest technologies, circuits and devices, practical hands-on sessions and simulations.

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12. the ecmo simulator #beach2019 (malbrain)

  1. 1. 3rd BEACHCourse Introduction 11-10-2019 ⎮ 1 3rd BEACH Course BElgian Annual eCmo Hands-on course Auditorium Kiekens Course Director: Prof. Dr. Manu Malbrain WORKSHOP UZ Brussels – Belgium: Oct 11 – 2019
  2. 2. 3rd BEACHCourse Introduction 11-10-2019 ⎮ 2 ECMO Simulator Manu Malbrain manu.malbrain@uzbrussel.be @manu_malbrain @Fluid_Academy
  3. 3. 3rd BEACHCourse Introduction 11-10-2019 ⎮ 3 An Introduction toVV ECMO Presentation by Andy Pybus Saint George Private Hospital MSE (Australia) PL www.ecmosimulation.com
  4. 4. 3rd BEACHCourse Introduction 11-10-2019 ⎮ 5 Simulator available at: www.ecmosimulation.com/downloads/ECMOSim260.zip
  5. 5. 3rd BEACHCourse Introduction 11-10-2019 ⎮ 6 Workshop Program: • Simulator components • The VV ECMO Paradigm • Patient selection • System / circuit design • Cannula selection and insertion • Anti-coagulation management • Basic VV ECMO manoeuvres • Ventilator management during VV ECMO • Basic problem solving during VV ECMO • Weaning from VV ECMO • Case Simulation
  6. 6. 3rd BEACHCourse Introduction 11-10-2019 ⎮ 7 Workshop Program: • Simulator components • The VV ECMO Paradigm • Patient selection • System / circuit design • Cannula selection and insertion • Anti-coagulation management • Basic VV ECMO manoeuvres • Ventilator management during VV ECMO • Basic problem solving during VV ECMO • Weaning from VV ECMO • Case Simulation
  7. 7. 3rd BEACHCourse Introduction 11-10-2019 ⎮ 8 Workshop Program: • Simulator components • The VV ECMO Paradigm • Patient selection • System / circuit design • Cannula selection and insertion • Anti-coagulation management • Basic VV ECMO manoeuvres • Ventilator management during VV ECMO • Basic problem solving during VV ECMO • Weaning from VV ECMO • Case Simulation
  8. 8. 3rd BEACHCourse Introduction 11-10-2019 ⎮ 9 Simulator Components: • Documentation Window • MonitorWindow • TherapyWindow • DeviceWindow • (Supervisor Window)
  9. 9. 3rd BEACHCourse Introduction 11-10-2019 ⎮ 10
  10. 10. 3rd BEACHCourse Introduction 11-10-2019 ⎮ 11
  11. 11. 3rd BEACHCourse Introduction 11-10-2019 ⎮ 12 Minimum Configuration = ‘Stick PC’ + Mobile Phone
  12. 12. 3rd BEACHCourse Introduction 11-10-2019 ⎮ 13 Your Resources:
  13. 13. 3rd BEACHCourse Introduction 11-10-2019 ⎮ 14
  14. 14. 3rd BEACHCourse Introduction 11-10-2019 ⎮ 15
  15. 15. 3rd BEACHCourse Introduction 11-10-2019 ⎮ 16
  16. 16. 3rd BEACHCourse Introduction 11-10-2019 ⎮ 17 Models: • Physiological – Cardiac, Respiratory, Neurological etc… • Pharmacodynamic – Relaxants, sedatives, Anticoagulants etc… • Mechanical – Ventilator, ECMO system, Defibrillator etc… • Update at between 0.4 and 100 Hz • Autonomous
  17. 17. 3rd BEACHCourse Introduction 11-10-2019 ⎮ 18 Models: • Lung Model – Riley – West • ECG Model – VF synthesis – Conduction pathway – ST Segment synthesis • Arterial tree Model – Aortic Valve – Eadyn • PK PD Models – Effect of ECMO – On coagulation – On fluid distribution
  18. 18. 3rd BEACHCourse Introduction 11-10-2019 ⎮ 19 Blood Gases Thermal Behaviour Vascular Pressures Myocardial Contractility ECG Respiratory Mechanics V:Q Relationship Starling Behaviour Baro - Reception CO2 Sensitivity Hypoxic Responses Chronotropy Inotropy PK Models Fluid Spaces NM Transmission Cannula Flow Mechanical Pumps BIS Hb Dissociation Model
  19. 19. 3rd BEACHCourse Introduction 11-10-2019 ⎮ 20
  20. 20. 3rd BEACHCourse Introduction 11-10-2019 ⎮ 39 Drainage (Venous ) Cannula: Extracorporeal membrane oxygenation using a centrifugal pump and a servo regulator to prevent negative inlet pressure. Pedersen TH, Videm V, Svennevig JL et al. Ann Thorac Surg. 1997 May;63(5):1333-9.
  21. 21. 3rd BEACHCourse Introduction 11-10-2019 ⎮ 40 Pressure Drop:
  22. 22. 3rd BEACHCourse Introduction 11-10-2019 ⎮ 41 Return (Arterial) Cannula: Basis for recommendation: ? Blood Flow: 5.0 lpm
  23. 23. 3rd BEACHCourse Introduction 11-10-2019 ⎮ 42
  24. 24. 3rd BEACHCourse Introduction 11-10-2019 ⎮ 47 BasicVV ECMO manoeuvres: We can change: • Gas flow. • Blood flow. • Temperature.
  25. 25. 3rd BEACHCourse Introduction 11-10-2019 ⎮ 48 VV ECMO: Basic Manipulations: Summary: • Adjusting Gas Flow will affect the PaCO2. • Adjusting Blood Flow will affect the PaO2. • Adjusting Temperature will affect the SvO2. Gas Flow Blood Flow Temperature (VO2)
  26. 26. 3rd BEACHCourse Introduction 11-10-2019 ⎮ 50 FGF = Fresh Gas Flow VV ECMO: Effect Of Gas Flow
  27. 27. 3rd BEACHCourse Introduction 11-10-2019 ⎮ 53 PaO2 and Blood Flow
  28. 28. 3rd BEACHCourse Introduction 11-10-2019 ⎮ 57 ECMO andTemperature Blood Flow: 5.0 lpm
  29. 29. 3rd BEACHCourse Introduction 11-10-2019 ⎮ 60 Ventilator Management Parameter Before After ECMO Blood Flow (lpm) 5.0 5.0 ECMO Gas Flow (lpm) 2.5 5.0 Ventilator Tidal Volume (mls) 500 200 Ventilator Frequency (bpm) 15 4 Ventilator PEEP (cm H2O) 10 10 Ventilator FiO2 1.0 0.6 PaO2 PaCO2 RESTING THE LUNG
  30. 30. 3rd BEACHCourse Introduction 11-10-2019 ⎮ 66 Oxygen Transfer
  31. 31. 3rd BEACHCourse Introduction 11-10-2019 ⎮ 76 Haematocrit and PaO2
  32. 32. 3rd BEACHCourse Introduction 11-10-2019 ⎮ 77 VV ECMO: Effect of ↑ Cardiac Output Competing influences: • PaO2 tends to rise because: – As CO ↑, so SvO2 ↑. – As SvO2 ↑↑, so SaO2 ↑↑.
  33. 33. 3rd BEACHCourse Introduction 11-10-2019 ⎮ 78 Competing Influences: • PaO2 tends to fall because: – As CO ↑, so fraction of CO passing through the oxygenator ↓ – As CO ↑, so Qs/Qt ↑ Lynch JP, Mhyre JG, Dantzker DR. Influence of cardiac output on intrapulmonary shunt. J Appl Physiol. 1979 Feb;46(2):315-21. VV ECMO: Effect of ↑ Cardiac Output
  34. 34. 3rd BEACHCourse Introduction 11-10-2019 ⎮ 79 VV ECMO: Net Effect of ↑ Cardiac Output Net Effect: As CO ↑, so PaO2 ↓.
  35. 35. 3rd BEACHCourse Introduction 11-10-2019 ⎮ 80 PK-PD (anti)coagulation
  36. 36. 3rd BEACHCourse Introduction 11-10-2019 ⎮ 81 Volume loading
  37. 37. 3rd BEACHCourse Introduction 11-10-2019 ⎮ 82 Blood loss
  38. 38. 3rd BEACHCourse Introduction 11-10-2019 ⎮ 89 VV-ECMO Case Simulation
  39. 39. 3rd BEACHCourse Introduction 11-10-2019 ⎮ 90 VV-ECMO Case Simulation
  40. 40. 3rd BEACHCourse Introduction 11-10-2019 ⎮ 91 VV-ECMO Case Simulation
  41. 41. 3rd BEACHCourse Introduction 11-10-2019 ⎮ 92
  42. 42. 3rd BEACHCourse Introduction 11-10-2019 ⎮ 93 RXThorax: ARDS
  43. 43. 3rd BEACHCourse Introduction 11-10-2019 ⎮ 94 ECG: Bigeminie
  44. 44. 3rd BEACHCourse Introduction 11-10-2019 ⎮ 95 TTEchocardio: Nl LVEF
  45. 45. 3rd BEACHCourse Introduction 11-10-2019 ⎮ 96 Lab Results
  46. 46. 3rd BEACHCourse Introduction 11-10-2019 ⎮ 97
  • NathyMorera

    Jun. 12, 2021
  • mohsensalah

    Nov. 30, 2019
  • DwightDumay

    Oct. 13, 2019

This workshop will outline the basic principles of extracorporeal life support made easy by key-experts in the field. During the course delegates will gain a good understanding of ECMO in the following areas: Theoretical concepts, basic physiology and pathophysiology, cardiac and respiratory support and monitoring, alarm settings and monitoring, role of cardiac ultrasound during ECMO, newest technologies, circuits and devices, practical hands-on sessions and simulations.

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