ECMO Circuits / Midterm Exam Flashcards
What are the two categories why we would ever need to place someone on ECMO?
- Severe Failure to oxygenate
- Cardiac Failure
Name three diffusion problems that would justify us placing a patient on ECMO?
- (HMD) Hyaline Membrane Disease
- (MAS) Meconium Aspiration Syndrome
- (ARDS) Acute respiratory distress syndrome
Name two perfusion problems that would justify us placing a patient on ECMO?
- (PPHN) Persistent pulmonary hypertension of the newborn
AKA (PFC) Persistent fetal circulation - CHD
Respiratory distress presents in the first few hours of life in a premature baby. Symptoms include tachypnea, expiratory grunting, nasal flaring. The infant may or may not be cyanosed. Substernal and intercostal retractions may be evident.
Risk factors include maternal diabetes, greater prematurity, prenatal asphyxia and multiple gestation.
Associated abnormalities are those that can occur in prematurity: intracranial haemorrhage, necrotising enterocolitis, patent ductus arteriosus, delayed developmental milestones, hypothermia and hypoglycaemia.
- Hyaline membrane disease(HMD), AKA
- Neonatal Respiratory Distress Syndrome,
- Lung Disease of Prematurity, or
- Surfactant Deficiency,
is a relatively common condition resulting from insufficient production of surfactant.
Pathophysiology of HMD ?
Immature type II pneumocytes cannot produce surfactant. The lack of surfactant lowers the surface tension in alveoli causing collapse. Patients have a decreased lecithin:sphingomyelin ratio. Damaged cells, necrotic cells, and mucus line the alveoli.
Subglottic stenosis can result from what ?
Long term intubation, this is why we trach our patients after we know that they are going to have to rely on a ventilator.
MAS
occurs secondary to intrapartum or intrauterine aspiration of meconium, usually in the setting of fetal distress, and usually in term or post-term infants.
Aspirated meconium can cause small airways obstruction and a chemical pneumonitis.
(PPHN) Persistent pulmonary hypertension of the newborn
AKA (PFC) Persistent fetal circulation
is a condition caused by a failure in the systemic circulation and pulmonary circulation to convert from the antenatal circulation pattern to the “normal” pattern.
Name three situations in which we would need to place on ECMO due to cardiac failure?
- Post Bypass
- BTT
- Bridge to recovery
Veno - Arterial ECMO cannulation ?
RA > Ao
3 Pros for Veno - Arterial ECMO ?
– Large body of experience
– Provides cardiac support
– High PaO2
3 CONS for Veno - Arterial ECMO ?
– “Cardiac Stun”
– Sacrifice Carotid artery
– Risk of arterial embolus
Veno - Venous ECMO cannulation ?
RA > RA via a duel lumen catheter
3 Pros for Veno - Venous ECMO ?
- No arterial embolus
- Oxygenated blood flow
into lung beds - Preserve carotid artery
3 CONS for Veno - Venous ECMO ?
- Recirculation = low PaO2
- No cardiac support
Cannulation sites for RESPIRATORY Veno - Arterial?
Right Internal Jugular => Right Common Carotid
Name the Cannulation sites for Respiratory Veno - Venous ?
Right internal Jugular
Name the 2 modes of Cannulation for CARDIAC Veno - Arterial?
• Trans-thoracic:
RA => Ascending Aorta
• Right IJ => Right Common Carotid
Name 5 determinants of venous drainage ?
- Patient volume status (cvp > 5)
- Cannula size and position
- Height of bed
- Patient position
- Kinks in venous line
Name 9 components of the ECMO circuit?
– Venous line – Bladder – Roller Pump – Oxygenator – Heat exchanger – Bubble detector – A-V Bridge – Sample Ports – Arterial line
Venous line drains blood from the RA, this allow for SVO2 monitoring through an oximetric catheter (SWAN-GANZ), what kind of data can we collect ?
- Adequacy of perfusion
- Recirculation
- Flow through cell
The BLADDER is a 30 ml silicone collapseable bag that acts as a safety device in 2 ways, what are they?
- Servoregulation of pump
* Bubble collection
The BLADDER’s actuation can be ?
- Mechanical or
- Pressure
The flow of the roller pump depends on what 3 things ?
- RPMs
- Tubing Size
- Proper Occlusion
