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.

1. Hemodynamic monitoring
Stefaan Bouchez, MD, FASE

2. Damn, ECMO again….

3. ECMO : - Oxygenation
- CO2 removal
- Circulatory flow
DO2 delivery

4. Physiologic concerns in cardiogenic shock (VA-ECMO)
- Myocardial salvage
- Minimize amount of myocardial loss
- Limit the amount of myocardial remodelling
- Improve survival
- How ?
- Reduce loading conditions & myocardial oxygen consumption

5. Circulatory IN-efficiency Tissue perfusion & Congestion
Low CO
Low VR

6. 0
10
20
30
40
50
60
70
80
CVP CI SBP Wedge
Renal Function
>32
<8
12
20
>24
<1,4
>2,6
<2 >2
<95 >125
<20
Mullens et al. J Am Coll Cardiol. 2009
Worseningkidneyfunction

7. ECMO – Cardiovascular Interaction
Pms – CVP = VR
1/ CVP decrease
2/ Pms ! (venous tone – volemia)
VA-ECMO increases preload
Afterload for LV
LVEDP & LV function
Cannula size & position

8. Maximum ECMO-flow is limited by venous return

9. Maximum ECMO-flow is limited by venous return

10. ECMO flow +++
LV ejection 0
ECMO flow +++
LV ejection +
ECMO flow +++
LV ejection ++
ECMO flow +++
LV ejection 0
ECMO flow +++
LV ejection +
ECMO flow +++
LV ejection ++
Native versus ECMO circulatory flow

11. ECMO flow +++
LV ejection +
Alwardt et al. JECT 2013

12. Respiratory function
&
Ventilator settings
Central venous pressure
Right ABP monitoring
Cerebral Oxymetry
Harlequin Syndrome

13. Afterload for LV
LVEDP & LV function

14. VA-ECMO : peripheral or central
Association of catecholamines !

16. VA-ECMO
Impella
LVAD
RV function = key

18. VA-ECMO + IMPELLA (ECPELLA)
Schrage et al. JACC Heart Fail 2018
Organ function (not the heart)

19. VA-ECMO + IMPELLA VA-ECMO + IABP

20. Arterial cannulation during support

21. Keebler et al. JACC Heart Fail. 2018
Weaning of ECMO
- Echocardiography
- Invasive monitoring ( ABP, CVP, PAC )
- NIRS

22. ECMO saves lives and organs
but counteracts the LV.
- Hemodynamic monitoring
- Harlequin syndrome
- Echocardiography
- Insertion & weaning
- Unloading & recovery
- Early unloading of the heart