Brief presentation on ECMO, approx 20 minutes.Mostly development with a couple of slides on clinical outcomes.

1. A brief overview of ECMO
(Extra Corporeal
Membrane Oxygenation)
CRAIG FARRINGTON RN DIP CCN 29/10/13

2. Overview
Definition
Indications
History
Clinical
outcomes

3. Definition
 “(ECMO)
a technique of providing
respiratory and cardiac support; the blood
is circulated through an artificial lung
consisting of two compartments separated
by a gas-permeable membrane, with the
blood on one side and the ventilating gas
on the other. It was originally used
exclusively in newborns but is now being
used more and more in adults.”

Miller-Keane Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health,
Seventh Edition. © 2003

4. Basic Schematic

5. Indications






Hypoxemic respiratory failure with a ratio of arterial oxygen tension to
fraction of inspired oxygen (PaO2/FiO2) of <100 mmHg despite
optimization of the ventilator settings (PEEP, FiO2)
Hypercapnic respiratory failure with an arterial pH <7.20
Refractory cardiogenic shock
Cardiac arrest
Failure to wean from cardiopulmonary bypass after cardiac surgery
As a bridge to either cardiac transplantation or placement of a
ventricular assist device

6. ECMO has it's origins in Cardiac
surgery



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Heart/Lung bypass technique established by
John Gibbon,1953 – Support time < 5 hours
First efficicent membrane oxygenators used in
1957 (Kammermeyer)
Steady improvement in membrane technology
in 60's
First VA support 1972 - 3 days support

7. Issues with ECMO
Thrombocytopenia
Coagulopathy
Haemolysis
Generalized edema, and
Deterioration of organ function

8. support time
Reducing Haemolysis and prolonging
support time
Reducing Haemolysis and prolonging
support time
Centrifugal
Roller Pump

10. Modern Polymethylpentene Membranes are now approved for
up to 14days continuous use.

13. Australian Experience - Swine 'flu 2009

Sixty-eight patients with severe influenza-associated ARDS were treated with
ECMO, of whom 61 had either confirmed 2009 influenza A(H1N1)

The 68 patients who received ECMO had a median range age of 34.4 (26.6-43.1)
years and 34 patients (50%) were men ..

The median duration of ECMO support was 10 (7-15) days.

At the time of reporting, 48 of the 68 patients (71%; 95% confidence interval [CI],
60%-82%) had survived to ICU discharge.

14. Australian Experience - Alfred study.
"Factors associated with outcomes of patients on
extracorporeal membrane oxygenation support:
a 5-year cohort study"
Cecile Aubron1, Allen C Cheng, David Pilcher, Tim Leong, Geoff Magrin, Jamie Cooper, Carlos
Scheinkestell and Vince Pellegrino.
Outcome: The
overall mortality was 37.3% (37.1% for the patients who
underwent VA ECMO, and 37.7% for the patients who underwent VV
ECMO)
Study was based on 151 patients tx from 2005-2011
most frequent complications during ECMO support were bleeding and
bloodstream infections regardless of ECMO type.

15. Questions?