3. ecmo different modes and principles va vv #beach2019 (taccone)
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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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3. ecmo different modes and principles va vv #beach2019 (taccone)
- 1. BEACH 2019 – FS Taccone T1T2T3T4T5T6 T7T8 T9 T10 T11T12L1L2L3 BEACH 2019 – FS Taccone ECMO Principles and Different Modes Fabio Silvio TACCONE, MD, PhD Dpt of Intensive Care Brussels, Belgium
- 2. BEACH 2019 – FS Taccone T1T2T3T4T5T6 T7T8 T9 T10 T11T12L1L2L3
- 3. BEACH 2019 – FS Taccone T1T2T3T4T5T6 T7T8 T9 T10 T11T12L1L2L3 WHAT IS ECMO ? V-V ECMO V-A ECMO
- 4. BEACH 2019 – FS Taccone T1T2T3T4T5T6 T7T8 T9 T10 T11T12L1L2L3 Extra-corporeal life support (ECLS) Cardiac ECLS Respiratory ECLS
- 5. BEACH 2019 – FS Taccone T1T2T3T4T5T6 T7T8 T9 T10 T11T12L1L2L3 RESPIRATORY ECLS VV-ECMO functions as an artificial lung working in addition to the patient's own failing lungs • To maintain gas exchanges • To allow protective ventilation • To allow “lung rest” • To allow “lung recovery” • To gain time for LTx
- 6. BEACH 2019 – FS Taccone T1T2T3T4T5T6 T7T8 T9 T10 T11T12L1L2L3 RESPIRATORY ECLS < CO SvO2 VO2
- 7. BEACH 2019 – FS Taccone T1T2T3T4T5T6 T7T8 T9 T10 T11T12L1L2L3 RESPIRATORY ECLS
- 8. BEACH 2019 – FS Taccone T1T2T3T4T5T6 T7T8 T9 T10 T11T12L1L2L3 RESPIRATORY ECLS
- 9. BEACH 2019 – FS Taccone T1T2T3T4T5T6 T7T8 T9 T10 T11T12L1L2L3 RESPIRATORY ECLS VCO2
- 10. BEACH 2019 – FS Taccone T1T2T3T4T5T6 T7T8 T9 T10 T11T12L1L2L3 RESPIRATORY ECLS
- 11. BEACH 2019 – FS Taccone T1T2T3T4T5T6 T7T8 T9 T10 T11T12L1L2L3 CARDIAC ECLS ECMO FLOW = CARDIAC OUTPUT VOLUME x PUMP (CANNULA) LIMB ISCHEMIA LUNG INJURY HARLEQUIN SYNDROME
- 12. BEACH 2019 – FS Taccone T1T2T3T4T5T6 T7T8 T9 T10 T11T12L1L2L3 The best perfusion flow Off-load the left ventricle Almost no pulmonary edema Very invasive (chest opening) Bleeding Infection Vascular injury (Aortic dissection) Significant risk of thrombosis CARDIAC ECLS VA-ECMO Central Cannulation
- 13. BEACH 2019 – FS Taccone T1T2T3T4T5T6 T7T8 T9 T10 T11T12L1L2L3 CARDIAC ECLS
- 14. BEACH 2019 – FS Taccone T1T2T3T4T5T6 T7T8 T9 T10 T11T12L1L2L3 CARDIAC ECLS
- 15. BEACH 2019 – FS Taccone T1T2T3T4T5T6 T7T8 T9 T10 T11T12L1L2L3 CARDIAC ECLS ECMO FLOW = CARDIAC OUTPUT VOLUME x PUMP (CANNULA) LIMB ISCHEMIA LUNG INJURY HARLEQUIN SYNDROME INCREASED AFTERLOAD
- 16. BEACH 2019 – FS Taccone T1T2T3T4T5T6 T7T8 T9 T10 T11T12L1L2L3 CARDIAC ECLS
- 17. BEACH 2019 – FS Taccone T1T2T3T4T5T6 T7T8 T9 T10 T11T12L1L2L3 CARDIAC ECLS
- 18. BEACH 2019 – FS Taccone T1T2T3T4T5T6 T7T8 T9 T10 T11T12L1L2L3 CARDIAC ECLS
- 19. BEACH 2019 – FS Taccone T1T2T3T4T5T6 T7T8 T9 T10 T11T12L1L2L3 ECLS
- 20. BEACH 2019 – FS Taccone T1T2T3T4T5T6 T7T8 T9 T10 T11T12L1L2L3 ECLS AND OTHER EXTRACORPOREAL THERAPIES RRT MV LIVER SUPPORT HEMOPERFUSION
- 21. BEACH 2019 – FS Taccone T1T2T3T4T5T6 T7T8 T9 T10 T11T12L1L2L3 Extra-corporeal life support (ECLS) Cardiac ECLS Respiratory ECLS VA-ECMO V-PA ECMO ECPR VV-ECMO V-PA ECMO AV-ECCO2R VV-ECCO2R Veno-artero-venous ECLS HYBRIDCOMBINED
- 22. BEACH 2019 – FS Taccone T1T2T3T4T5T6 T7T8 T9 T10 T11T12L1L2L3
Editor's Notes
- HOW IT WORKS ?
- 47% vs 63% (22/90 not ECMO – mortality 18%!!!) – no difference on good outcome
- HOW IT WORKS ?
- 47% vs 63% (22/90 not ECMO – mortality 18%!!!) – no difference on good outcome
- CARDIAC INJURY = afterload < increase BP / aortic regurgitation
- Central cannulation when oxygenation is not needed anymore – two circuits with cannulation of heart chamber (usually apex but also atria) excellent means of unloading the heart and maintaining the blood flow via pulmonary vasculature
- Without the oxygenator – it would be considered as a temporary VAD Femoral requires often a reperfusion catheter to avoid limb ischemia But also axillary or carotid
- Without the oxygenator – it would be considered as a temporary VAD Femoral requires often a reperfusion catheter to avoid limb ischemia But also axillary or carotid
- CARDIAC INJURY = afterload < increase BP / aortic regurgitation