Extra Corporeal Membrane Oxygenation ECMO Extra Corporeal Membrane Oxygenation

Extracorporeal membrane oxygenation ECMO

ECMO Extracorporeal membrane oxygenation (ECMO) is a special procedure that uses an artificial heart-lung machine to take over the work of the lungs (and sometimes also the heart). ECMO is used most often in newborns and young children, but it also can be used as a last resort for adults whose heart or lungs are failing.

ECMO Indications… ECMO is used to treat respiratory or cardiac failure that is unresponsive to all other measures but is considered to have a reversible cause.

ECMO For example… meconium aspiration syndrome persistent pulmonary hypertension respiratory distress syndrome congenital diaphragmatic hernia, pneumonia Heart failure

ECMO Types:Venoarterial (V-A) ECMO Supports the heart and lungs.

ECMO Venovenous (V-V) ECMO: supports the lungs only

ECMO Goals Improvement in Q (cardiac output), although no more than 50% of the workload Gas exchange Oxygenation CO2 is titrated INTO the circuit to compensate for such efficent removal!

ECMO Selection Criteria Mech ventilation for less than 14 days Gestational age >33 weeks Weight .1.8 kg Reversible disease process Failure of maximal medical management Predicted mortality >80%

ECMO Exclusion criteria: Major intracranial hemmorage Lethal malformation Severe neurologic injury Uncontrolable coagulopathy Syndrome with poor prognosis

ECMO Clinical indications Oxygen Index (OI) >40 PaO2 < 40 mmHg while on 100% FIO2 X 4 hours Intractable metabolic acidosis Intractable shock Progressive and intractable pulmonary or cardiac failure

ECMO References: http://www.healthatoz.com/healthatoz/Atoz/ency/extracorporeal_membrane_oxygenation.html, www.nice.org.uk/article, http://www.ucsfhealth.org/childrens/health_professionals/manuals/12_ECMO.pdf

2247 Specialties Closing remarks: ECMO is the height of clinical skill and training, and even if you choose not to participate in ECMO, be a practitioner worthy of this level of skill….don’t stop learning!