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
BEACH 2019 – FS Taccone
T1T2T3T4T5T6
T7T8
T9
T10
T11T12L1L2L3
BEACH 2019 – FS Taccone
T1T2T3T4T5T6
T7T8
T9
T10
T11T12L1L2L3
WHAT IS ECMO ?
V-V ECMO V-A ECMO
BEACH 2019 – FS Taccone
T1T2T3T4T5T6
T7T8
T9
T10
T11T12L1L2L3
Extra-corporeal life support
(ECLS)
Cardiac ECLS Respiratory ECLS
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
BEACH 2019 – FS Taccone
T1T2T3T4T5T6
T7T8
T9
T10
T11T12L1L2L3
RESPIRATORY ECLS
<
CO
SvO2
VO2
BEACH 2019 – FS Taccone
T1T2T3T4T5T6
T7T8
T9
T10
T11T12L1L2L3
RESPIRATORY ECLS
BEACH 2019 – FS Taccone
T1T2T3T4T5T6
T7T8
T9
T10
T11T12L1L2L3
RESPIRATORY ECLS
BEACH 2019 – FS Taccone
T1T2T3T4T5T6
T7T8
T9
T10
T11T12L1L2L3
RESPIRATORY ECLS
VCO2
BEACH 2019 – FS Taccone
T1T2T3T4T5T6
T7T8
T9
T10
T11T12L1L2L3
RESPIRATORY ECLS
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
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
BEACH 2019 – FS Taccone
T1T2T3T4T5T6
T7T8
T9
T10
T11T12L1L2L3
CARDIAC ECLS
BEACH 2019 – FS Taccone
T1T2T3T4T5T6
T7T8
T9
T10
T11T12L1L2L3
CARDIAC ECLS
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
BEACH 2019 – FS Taccone
T1T2T3T4T5T6
T7T8
T9
T10
T11T12L1L2L3
CARDIAC ECLS
BEACH 2019 – FS Taccone
T1T2T3T4T5T6
T7T8
T9
T10
T11T12L1L2L3
CARDIAC ECLS
BEACH 2019 – FS Taccone
T1T2T3T4T5T6
T7T8
T9
T10
T11T12L1L2L3
CARDIAC ECLS
BEACH 2019 – FS Taccone
T1T2T3T4T5T6
T7T8
T9
T10
T11T12L1L2L3
ECLS
BEACH 2019 – FS Taccone
T1T2T3T4T5T6
T7T8
T9
T10
T11T12L1L2L3
ECLS AND OTHER EXTRACORPOREAL THERAPIES
RRT MV
LIVER
SUPPORT
HEMOPERFUSION
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
BEACH 2019 – FS Taccone
T1T2T3T4T5T6
T7T8
T9
T10
T11T12L1L2L3

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

  • #7 HOW IT WORKS ?
  • #8 47% vs 63% (22/90 not ECMO – mortality 18%!!!) – no difference on good outcome
  • #10 HOW IT WORKS ?
  • #11 47% vs 63% (22/90 not ECMO – mortality 18%!!!) – no difference on good outcome
  • #12 CARDIAC INJURY = afterload < increase BP / aortic regurgitation
  • #13 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
  • #14 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
  • #15 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
  • #16 CARDIAC INJURY = afterload < increase BP / aortic regurgitation