ECMO Flashcards
Discuss indications for ECMO
Criteria for the initiation of ECMO include acute severe cardiac or pulmonary failure that is potentially reversible and responsive to conventional management
1) hypoxic respiratory failure with a PF ratio of <100 despite optimization of ventilator setting
- The Berlin consensus document on acute respiratory distress syndrome suggest ECMO in severe respiratory failure (PF ratio of <70)
2) Hypercapnic respiratory failure with arterial PH of less tahn7.2 despite optimisation
3) Ventilatory support as a bridge to lung transplant
4) cardiac/circulatory failure/ refractory shock including RV failure
5) massive PE
6) cardiac arrest
7) Failure to wean from bypass after cardaic surgery
8) as a bridge to either caridac or lung transplantation or placement of a ventricular assist devise
Contraindications
- pre-existing condition that is incompatible with recovery
- uncontrollable bleeding and very poor prognosis from the primary condition
Discuss evidence for ECMO
Acute respiratory failure
1) CESAR trial found benifit for early referral to ECMO centre - hetrogenous ventilator setting as primary
2) EOLIA - favor of ECMO for improved oxygenation, more days free of renal failure and fewer patients with ischaemic stroke.
Cardiac failure
-Associated with increased survival in cardaic arrest compaired to standard CPR
-
Discuss complciations of ECMO
Bleeding - occurs in 30-50% of patients who receive ECMO and can be life threatening
VTE - systemic thromboembolism due to thrombus formation within the extracorporeal circuit is a complications that can be devastating
Neuro - CVA
Cannulation releated - vessel perforation with haemorrhage, arterial dissection, distal ischaemia and incorrect location
HITS
VA specific
- pulmonary haemorrahge
- cardiac thrombosis - retrograde bloodflow in the ascending aorta wheneber the femoral arteyr and vein are used for VA ECMO
- Coronary or cerbral hypixa
- Distal ischaemia
- Neuro injury
