An extracorporeal membrane oxygenation–based approach to cardiogenic shock in an older population Christopher Smith, Rinaldo Bellomo, MD, Jai S Raman,

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Presentation transcript:

An extracorporeal membrane oxygenation–based approach to cardiogenic shock in an older population Christopher Smith, Rinaldo Bellomo, MD, Jai S Raman, George Matalanis, Alexander Rosalion, Jonathan Buckmaster, MD, Graeme Hart, MD, William Silvester, MD, Geoffrey A Gutteridge, Ben Smith, Laurie Doolan, MD, Brian F Buxton The Annals of Thoracic Surgery Volume 71, Issue 5, Pages 1421-1427 (May 2001) DOI: 10.1016/S0003-4975(00)02504-2 Copyright © 2001 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Diagram showing the position and exit site of intrathoracic cannulas used for extracorporeal membrane oxygenation. The Annals of Thoracic Surgery 2001 71, 1421-1427DOI: (10.1016/S0003-4975(00)02504-2) Copyright © 2001 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Illustration of the preferred site for extrathoracic cannulation for extracorporeal membrane oxygenation. The Annals of Thoracic Surgery 2001 71, 1421-1427DOI: (10.1016/S0003-4975(00)02504-2) Copyright © 2001 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Diagram illustrating the appearance and position of the arterial cannula used for the return limb of the extracorporeal membrane oxygenation (ECMO) circuit. The Annals of Thoracic Surgery 2001 71, 1421-1427DOI: (10.1016/S0003-4975(00)02504-2) Copyright © 2001 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Illustration of one of the techniques used to ensure maintenance of blood flow to the distal lower limb during femoral cannulation. The side cannula entering the femoral vessel distal to the cannulation site ensures flows greater than 150 mL/min. (ECMO = extracorporeal membrane oxygenation.) The Annals of Thoracic Surgery 2001 71, 1421-1427DOI: (10.1016/S0003-4975(00)02504-2) Copyright © 2001 The Society of Thoracic Surgeons Terms and Conditions

Fig 5 Illustration of the T-graft approach to maintaining both central arterial blood flow and distal lower limb perfusion. A polyethylene terephthalate graft is attached to the femoral artery, and the cannula is inserted into and tied to the graft. (ECMO = extracorporeal membrane oxygenation.) The Annals of Thoracic Surgery 2001 71, 1421-1427DOI: (10.1016/S0003-4975(00)02504-2) Copyright © 2001 The Society of Thoracic Surgeons Terms and Conditions

Fig 6 Diagram illustrating the internal and external appearance of a double-lumen dialysis catheter used for continuous hemofiltration in all of our patients. The Annals of Thoracic Surgery 2001 71, 1421-1427DOI: (10.1016/S0003-4975(00)02504-2) Copyright © 2001 The Society of Thoracic Surgeons Terms and Conditions