ecmo is - dependent and - sensative
preload
afterload
VA complications
lv stun
lv dysfunction after reperfusion
lv overdistends and can’t contract adequately
VA complications
lv stun- s/s and dx
lose pulse p <10mmHg
flattened a line
dec co and map
dx w/ echo
VA complications
lv stun- treatment
adjusting flow up or down pt dependent
inc flow try and jump start heart (can inc afterload and results in further pulm edema)
dec flow
temporarily reduce stress on heart and give it a sec to stop quivering
maximize preload
give vol
ensure O2 carry capacity adeq
prbc
maximize post oxygenator o2 content
inc fio2
inotropes
reduce afterload
diuretics
mechanical offload LV
shunt to RA or aorta (peds)
impella
iabp
VV complications
rv stun
**pulm htn PRE ecmo
ecmo initiation exacerb RV dilation
vent. septum bowing
LV HF
dec CO
VV complications
rv stun- s/s and dx
dec co
inc cvp
dx w/ echo
VV complications
rv stun- treatment
reduce RV afterload aka P in pulm system
veletri
nebs
VV/VA complications
cardiac stun
rv and or lv
usually resolves over 48h
if not fixed w/in 4-5 days
r/o other etiologies myocarditis, MI
damage often irreversible
VV/VA complications
arrhythmias
VA- NOT emergent
urgent, check lytes
ensure cannula and any other assist devices are in correct positions
start gtt
cardiovert?
can be common after cardiac sx
VV- can be emergent if hemodynamically compromising
ecmo respir main goal v secondary
main
prevent further barotrauma/ lung injury
reduce oxygen toxicity
secondary
maintain patency of respir system
recruit lung vol (slowly based on cxr and vent compliance)
ABG targets
ph 7.35-7.45
pco2 45-65 (ok for permissive hypercap)
pao2 75-100
>50-60
**expect to be lower w/ VV
sao2 80-100%
respir complications
pnemo/hemothorax- s/s and trtment
rapid or delayed
dec TV
tachycardia
dec BP
SUDDEN dec in venous return/ chugging
trtmtnt- cxt tube
respir complications
pulm hemorr- s/s and trtmnt
dec anticoag lvl
give plt/cryo/ffp
inc PEEP
minim suctioning
bronch
can clamp ett (only if absol. necessary)
24-48hr
neuro complications
ICH
more common in neonates
usually reperfusion injury
very suseptible in extreme labile BP
inc CVP
initiate ecmo flows slowly
secondary causes
anticoag
mode of dialysis
cvvhdf
hemofiltration and hemodialysis
dec pump flow- s/s and troubleshooting
dec venous P
poor perfusion dec svo2
pt pao2=post oxygenator po2 (aka no native co)
inability to maintain ecmo flow
temp. dec rpm and flow
give volume
code drugs
defib/cardiovert
cpr if vv
ecmo triad
inc hr
dec map
narrow PP (<10 bad)
o2 consumption- factors
vo2
changes in metab
inc consumption
fever, infection, hr, etc
reflected in DEC pt pao2
dec consumption
sedation, cooling, rest
vo2 equation
gross o2
co (hr x sv) x (arterial-venous consumption)
amnt o2 put into arterial - amnt o2 remaining in vein
Factors Affecting O2 Delivery
(excl ecmo circuit)
(Do2)
hgb
pao2 and sao2
co
hr x sv
sv (afterload, preload, contractiity)
fio2
o2 delivery factors incl ecmo
ecmo
oxygenator function
blood oxygen sat
ecmo pump flow
pt
native lung/ co
oxygen consumption
ecmo o2 delivery- blood o2 sat
eval function of oxygenator w/ pre and post memb ABG
looking to see if arterial pao2 is x5 venous pao2
ecmo o2 delivery-
post oxygenator goal sao2 and pao2
sao2> 90%
pao2 200-300
ecmo o2 delivery
ways to inc
inc flow
transfuse hgb
inc fio2 to oxygenator
dec consumption
