ECMO

1. ECMO
JINIL RAJ
Lisie heart institute

2.  Extracorporeal technique
 Temporary life support
 Potentially reversible cardiac and respiratory
insufficiency
 Failing to respond to conventional medical
therapy.
Extracorporeal membrane oxygenation (ECMO)

3.  Adaptation of conventional cardiopulmonary bypass
techniques used in OR for prolonged support in ICU.
 Does not treat the underlying disease process.
 Aids in recovery by unloading the cardiopulmonary
system.
 Can serve as a bridge to organ transplant.

5. FATHER OF ECMO
In 1975,reports of the
first successful instance
of a newborn infant
sustained using ECMO
under the care of
Dr.Bartlett, who is today
called the
‘Father of ECMO’.

7.  VENO-ARTERIAL ECMO
 VENO-VENOUS ECMO
Types of ecmo....

8.  For cardiac support
 Cannulation from a venous side to an arterial
side.
 Central – right atrium to ascending aorta.
 Periferal – femoral /internal jugular vein to
femoral /carotid artery.
 Cannulation sites differs according to the
anatomy and pathology.
VENO ARTERIAL ECMO

9.  Post cardiotomy cardiac failure.
 Cardiomyopathies
 Viral myocarditis.
 Bridge to transplant.
Common indications.

10. In the ICU: the severity defined by pressor and
inotropic requirement, metabolic acidosis,
decreased urine output for 6 hours.
pH<7.25 with raised lactates .
 Early postoperative cardiac failure in the operating
room (unable to come off bypass)
 Cardiac arrest from any cause
 Septic shock without evidence of coagulopathy or
multiorgan damage.
 Elective support through high risk catheter
procedures
when to start Ecmo.....

11.  For lung support.
 Cannulation – from a large vien to another.
 femoral vein and internal jugular vein.
 Can use a single double lumen cannula.
Veno - venous ecmo

12.  Can be used for anything causing ARDS.
 -mechonium aspiration.
 -congenital diaphragmatic hernia
 -persisant pulmonary hypertension.
 -Status asmaticus.
 - snake bite.
 -organic phosphorus poisoning.
 Sepsis.
Common indications

13.  Severe resp. failure
O.I (Oxygenation Index) – M.A.P X FiO2/
PaO2
O.I > 40 on conventional vent. for 6hrs
Uncorrectable hypercarbia with pH <7
MAP more than 30 is the sign of barotrauma
When do we initiate an ECMO in
Resp.Failure........

14. ECPR

15.  Ecmo after an effective CPR.
 Neuro protection is crittical.
ECPR

16.  To treat hypercarbia.
 No active support to lung.
 Ecmo flow through the membrane lung.
 Flow is driven by patient’s arterial pressure and
volume load.
 It is less invasive and keep the patint in
isobalance state.
ETCO2 REMOVAL

17. NOVA LUNG

18. “The key to the success of
ECMO may be the time of
initiation”

19. Improper selection can result in a
‘ bridge to nowhere’ situation
Proper selection is mandatory.

20. • Absolute
Incurable malignancy
Severe neurological compromise
Lethal chromosomal abnormalities
coagulopathy
Contraindications....

21. ECMOProgram director
Critical care specialist/CTVsurgeon
ECMO Coordinator
Physician/perfusionist
ECMO Clinical SPECIALIST
clinicians NURSING STAFF
SUPPORT STAFFS
Respiratory
therapists/biomedical staffs

25. LET’S PARTY
NOW
…
.