2. Extracorporeal Life Support
Systems’ Nomenclature
ECLS: ExtraCorporeal Life Support
ECMO: Extracorporeal Membrane
Oxygenation
iLA: Lung Assist
ECCO2R: Extracorporeal CarbonDioxide
Removal
VAD: Ventricular Assist Device
3. ECMO is a Type of ECLS
2 Main Physiologic Functions
Pulmonary Gas Exchange through an artificial
‘lung’ or MEMBRANE
1. O2 delivery to meet metabolic needs
2. Removal of CO2
Care of patient on ECMO involves exposure to
anticoagulation and transfusion therapy
4.
5. Indications: Purpose > Diagnosis
1. Bridge to organ recovery
• To provide time needed for recovery of
function
• To facilitate therapy: surgery or medical
2. Bridge to receive organ transplant
3. Bridge to decision:
• To palliative care
6.
7.
8. Need: Modes & Configurations
Cardiopulmonary failure
• Cardiac or cardiopulmonary support
• Veno-Arterial VA ECMO
Respiratory failure
• Respiratory Support
• Veno-venous or VV ECMO
Respiratory Support with Right Heart Failure
• Pulmonary artery- to left atrium iLA
9.
10.
11.
12. Considerations > Contraindications
Irreversible lung or heart disease
• And organ transplantation is not an option
Massive active hemorrhage
Uncorrectable coagulopathy
Major acute intracranial hemorrhage
Multi-organ failure
13. CESAR TRIAL 2009
180 patients – ECMO / Conventional
63% survival at 6months in ECMO group Vs
47% in conventional group
Technically flawed due to different levels of
care
Summary : Mortality difference observed
cannot be attributed to ECMO
14. AUSTRALASIAN 2009 H1N1 EXPERIENCE
ECMO found a 21% survival rate at 3 months
Mortality in Non – ECMO group only 13%
15. EOLIA TRIAL 2018
NO MORTALITY DIFFERENCE – ECMO VS
CONVENTIONAL VENTILATION
CONTROLS – 90% PRONE VENTILATED
PRONE VS ECMO
28% OF CONTROLS (SICKER AT
RANDOMISATION) MIGRATED TO ECMO WHICH
MADE RESULTS DIFFICULT TO INTERPRET
SUMMARY(HARDIN &HIBBERT 2018,NEJM)):
TRIAL SUPPORTS USE OF ECMO WHO HAVE
CLEARLY EXCEEDED CONVENTIONAL VENTILATION
AND PRONE POSITION
16.
17.
18.
19. Cannulation
Vascular access:
• Peripheral: neck and femoral
• Central
Sites:
• Single or dual or more
Cannula Types:
• Lumens: single, dual, multiple
• Flow rate capacity (L/min)
20.
21.
22.
23.
24. COMPLICATIONS
• Bleeding
Cerebral hemorrhage or stroke Surgical site
hemorrhage
• Ischemia & end organ multi-organ failure
• Stroke & Limb Ischemia
• Renal failure
• Lung injury or failure of lung recovery
• Skin ulcerations
• Infection & systemic inflammatory syndrome
• Exposure to transfusions and other blood
products
• Pain, delirium, fear, awareness if awake &
NMB
25. Complications - Mechanical
• Pump
• Membrane failure
• Air embolism
• Catheter related vascular or cardiac
perforation
• Circuit clotting & Haemolysis
