ECMO introduction

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ECMO introduction

• Dr. Shen, Mei-Ling
• Department of Anesthesia
• Chinese Medical University Hospital

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• ECMO
• ???
• extracorporeal membrane oxygenation

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• ECMO v.s. CPB
• Prolonged partial cardiopulmonary bypass
• Venous reservoir

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ECMO
CPB
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(No Transcript)
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• Clinical role of ECMO
• Short-term cardiopulmonary support
• Buy time for the next step
• Recovery
• Transplantation
• Long-term device
• Operation
• Give up

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• ECMO for lung
• Support
• O2 supply CO2 removal
• Rest
• reduce ventilator induced lung injury

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• ECMO for heart
• Support
• improve systemic perfusion
• Rest
• decrease preload requirement and congestion
• Decrease catecholamine
• Decrease myocardial work

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• ECMO component
• Pump
• Oxygenator
• Gas flow meter
• Heater
• Monitor
• Cannula
• Circuit

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• ECMO mode
• VV ECMO
• VA ECMO

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• VV ECMO
• Indication
• For lung disease only
• Purpose
• To decrease barotrauma

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• VA ECMO
• Indication
• Both lung and heart support
• Purpose
• For hemodynamic support

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• ECMO indications approved by NHI
• Cardiogenic shock
• Post-operative heart failure, for
  transplantation, myocarditis
• Respiratory failure ARDS
• Ped. Neonate
• MAS, CDH, Hyaline membrane disease
• Others
• Neurosurgery
• Lung transplantation

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• ECMO contraindications
• Post-operative or post-traumatic 24 hours
• Head injury associated with intracranial
  hemorrhage 72 hours
• Hypoxic encephalopathy
• Malignancy
• ARDS associated COPD
• Irreversible condition

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• Treatment of low cardiac output
• Drug
• Digoxin, diuretics, ACEI carvedilol milrinone
  dopamine, dobutamine, epinephrine,
  norepinephrine, PGE1, NO inhalation
• Mechanical circulatory support
• IABP, VAD, ECMO
• Surgery

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• Advantage of ECMO
• Rapid priming, bedside, local anesthesia
• Easy, quick, safe (ECPR)
• Cheaper than VAD
• Support for RV, LV, lung
• Carmeda Bioactive Surface
• For both adults and children
• Neck, femoral, thoracic

flexible
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• Complications of ECMO(1)
• Neurologic complications
• Seizure, ICH, infarction
• Hemorrhage complications
• Hemolysis, hemorrhage
• Cardiac complications
• Arrhythmia, pericardial tamponade
• Pulmonary complications
• Pneumothorax, pulmonary hemorrhage

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• Complications of ECMO(2)
• Renal complications
• Oliguria, ATN
• Gastrointestinal complications
• ischemia
• Infection
• sepsis
• Metabolic complications
• Drug interaction

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• What should anaesthetists anesthesiologists do
  in ECMO ?
• Adequate anesthesia
• Ventilation support
• Monitoring
• Drugs
• Transfusion

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The end !