Presented by Nai-Hsin Chi National Taiwan University Hospital ECMO extracorporeal membrane oxygenation extracorporal life support 2010/9/22 Presented by Nai-Hsin Chi National Taiwan University Hospital

ECMO  prolonged partial cardiopulmonary bypass

ECMO vs CPB reservoir

CPB vs ECMO Yes Yes in high flow

composite of ECMO Blood pump centrifugal pump membrane oxygenator roller pump+ control-bladder membrane oxygenator hollow fiber oxygenator silicone membrane oxygenator Heater

ECMO 機器

ECMO主機

Centrifugal pump

滾輪式幫浦加囊狀控制裝置

Pig-Tail 排氣用 接氧氣

Cannula

Arterial cannula

MX-2 monitor

氣體流量表

ECMO Short-term cardiopulmonary support 1-2 weeks Bridge to decision Buy time to decide the next step Recovery Transplantation long-term device (ventricular assist device) Operation (CABG, pulmonary embolectomy,..) Give-up

for lung 1. support : O2 supply & CO2 removal 2. rest : reduce ventilator induced lung injury

for heart support : improve systemic perfusion rest : ↓catecholamine ↓myocardial work decrease preload requirement and congestion

ECMO Type VV - ECMO VA - ECMO

VV-ECMO indication : for lung disease only purpose : to decrease barotrauma ventilator setting : PC mode, PEEP >10 , PIP < 35 , VR --> PaCO2, FiO2--> PaO2

VA-ECMO advantage : 1. both lung & heart support

Application of ECMO As a mechanical circulatory support: Post-cardiotomy cardiogenic shock Double bridge (ECMO VAD HTx) Acute myocarditis AMI cardiogenic shock (ECPR) Rescue for acute pulmonary embolism Ventilatory support ARDS Neonatal pulmonary diseases

Different patients Different situation  Different treatment t

ECMO in NTUH 1994 Aug. 11  2003 Dec. 31

ECMO工作車 All you need to set up ECMO Put everything on the wheel Then, OR, ICU, cath room, ES, ward, etc

Bleeding Anticoagulation Thrombus

尿紅

Five-Year Results of 219 Consecutive Patients Treated With Extracorporeal Membrane Oxygenation for Refractory Postoperative Cardiogenic Shock Ann Thorac Surg 2004; 77:151-7

Results Mortality Cause : 86 (39%) did not improved and weaning 133 (61%) successfully weaned from ECMO Mortality Cause : Refractory myocardial failure : 118(71%) MoF : 24(14%) Cerebral infarction/bleeding : 8(5%) Sepsis : 6(4%) ARDS: 4(2.5%) DIC : 2(1%) Bowel ischemia : 2(1%) Pulmonary embolism: 2(1%) ET tube into esophagus : 1(0.5%) 52 (39%) discharge Mean hospital stay: 29.924 days

Bridge VAD : 8 Transplant : 4 survival HeartMart : 2 Heart Transplant : Survival Berlin Heart : 6 (Biventricular : 4, Univentricular : 2) Successfully weaning : 1 Die : 5

ECMO Short-term cardiopulmonary support 1-2 weeks Bridge to decision Buy time to decide the next step Recovery Transplantation long-term device (ventricular assist device) Operation (CABG, pulmonary embolectomy,..) Give-up

ECMO Advantage: Both children & adult (wide range of BW) Flexible cannulation site: femoral, neck, chest Higher support Rapid & easy set-up & remoral Disadvantage: Bleeding Bedridden Infection SIRS Labor-intensive Partial CP support

Thank you